System for Maximizing the Effectiveness of Care Giving

ABSTRACT

A method for determining the performance of a caregiver in a monitoring system for monitoring a user in a user living area the monitoring system including a remote monitoring site, including monitoring the user living area to detect an occurrence of an event to provide a detected event, providing event information representative of the detected event and determining a response of the caregiver to the detected event to provide caregiver response information. The event information and the caregiver response information are transmitted to the remote monitoring site.

BACKGROUND OF THE INVENTION

1. Field of Invention

This invention relates to a system for providing remote monitoring andintervention to maintaining independent living.

2. Description of Related Art

All references cited herein are incorporated herein by reference intheir entireties.

BRIEF SUMMARY OF THE INVENTION

A method for determining the performance of a caregiver in a monitoringsystem for monitoring a user in a user living area the monitoring systemincluding a remote monitoring site, including monitoring the user livingarea to detect an occurrence of an event to provide a detected event,providing event information representative of the detected event anddetermining a response of the caregiver to the detected event to providecaregiver response information. The event information and the caregiverresponse information are transmitted to the remote monitoring site.

BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofpreferred embodiments of the invention, will be better understood whenread in conjunction with the appended drawings. For the purpose ofillustrating the invention, there is shown in the drawings embodimentswhich are presently preferred. It should be understood, however, thatthe invention is not limited to the precise arrangements andinstrumentalities shown. In the drawings:

FIG. 1 is a block diagram representation of the user monitoring systemof the present invention;

FIG. 2 is a more detailed block diagram representation of the systemcontroller device of FIG. 1;

FIG. 3 is a block diagram representation of the movement activitydetection subsystem of the user monitoring system of FIG. 1;

FIGS. 4A, B are side and top plan views of the medicationself-management detection subsystem of the user monitoring system ofFIG. 1;

FIG. 5 is a more detailed block diagram representation of the medicationself-management detection subsystem of FIGS. 4A, B;

FIG. 6 is a block diagram representation of the gas stove safetydetection subsystem of the user monitoring system of FIG. 1;

FIG. 7 is a block diagram representation of the electric stove safetydetection subsystem of the user monitoring system of FIG. 1;

FIG. 8 is a more detailed schematic representation of the current drainmonitor of the electric stove safety detection subsystem of FIG. 7;

FIG. 9 is a schematic representation of the water overflow detectionsubsystem of the user monitoring system of FIG. 1;

FIG. 10 is a block diagram representation of the auxiliary appliancedetection subsystem of the user monitoring system of FIG. 1;

FIGS. 11A-11M are flow charts representing operations performed withrespect to the various subsystems of the system of FIG. 1.

FIG. 12 is a block diagram representation of the user monitoring systemof FIG. 1 wherein the internet is used as the communication channel.

FIG. 13 is a flow chart representing operations performed by a caregiverin response to the detection of an event.

FIGS. 14A, B show client summary page alerts according to the presentinvention.

FIGS. 15A, B show TAO summaries according to the present invention.

FIGS. 16A-E show further TAOs according to the present invention.

FIGS. 17A-C show a care tracking report according to the presentinvention.

FIGS. 18A-C show an individual wellbeing record.

FIGS. 19A, B show a TAO summary.

DETAILED DESCRIPTION OF THE INVENTION

Several known user monitoring systems have an immediate responsefeature. In one prior art system if a user falls down and is unable toget up the user may push a button on a small radio frequencytransmitter. This radio frequency transmitter may be worn by the user.For example, it may be worn on a necklace or on a key chain forconvenience and to assure that it is available when it is needed.Pushing the button activates a device at the residence of the user whichplaces a telephone call to a user remote monitoring site. Personnel atthe remote monitoring site may listen and talk through a pagingtelephone in order to communicate with the user. Additionally, personnelat the user monitoring site may dispatch an ambulance or otherassistance for the user.

There is a large number of devices designed to enhance medicationcompliance and to monitor the extent of noncompliance. Devices availablein the prior art include timers, medicament containers and combinationsof timers and containers. Also available in the prior art are multiplecompartment timed containers which only open at timed intervals and beepuntil the compartment is opened and closed. Devices available toresearchers include specialized containers and bottle caps which recordthe date and time of opening of the container. This information isprovided in a machine transferable form which may be applied to acomputer for analysis of scheduling and dosing compliance.

In addition, a variety of specialized dispensers using stripped, bubblewrapped medicaments is available. These dispensers are available frompharmacists and are adapted to provide the correct pills at scheduledtimes and use a less expensive method for loading doses than other priorart self-loading timed dispensers. One prior art system in particularuses a host computer system to control a dispensing schedule in additionto a local timer-memory system. Another system uses color coded indiciato aid in identification of medication by users.

Various home health monitoring systems are also known in the prior art.These systems fall into a broad category of devices which offer in-homeelectronic monitoring of health conditions ranging from fetal heart beatto blood pressure and blood sugar. Some of these health monitoringsystems transmit a log to a central unit if a monitored parameter isoutside a predetermined range. Other systems monitor predeterminedhealth related parameters in the environment of the user.

The present invention comprises a user monitoring system for monitoringand intervening in selected activities of daily living for usersrequiring differing levels of monitoring or supervision. The usermonitoring system monitors and provides interventions relating to fourprincipal event domains. These event domains are (1) movement around thehome, (2) medication compliance by the user, (3) problems with usage ofstoves or other potentially dangerous appliances, and (4) selectedauxiliary appliance control. Each of these event domains corresponds toa detection subsystem of the user monitoring system. Each detectionsubsystem is linked to the user monitoring system by means of radiofrequency signals transmitted from subsystem sensors and received by asystem controller device within the user monitoring system. In additionto using information obtained by monitoring the selected activities ofdaily living to make decisions locally, the user monitoring systemproduces, stores and transfers data concerning all monitored eventdomains and intervention activity to a remote case management system forfurther analysis and intervention. The remote case management monitoringsystem may use a knowledge base and an inference generator in order tomake decisions regarding various types and degrees of intervention. Theuser monitoring system may provide reminders for the user to take theirmedications. Local and remote reprogramming of event parametersdetermining interventions and data recording are provided. The usermonitoring system may execute controlled shutdown of the stove and otherappliances as well as call the remote monitoring site in the event ofpossible emergencies. Data for monthly case monitoring reports which mayinclude event logs of problem occurrences may be provided to permitcross-sectional and long-term trend analysis of difficulties. These mayserve as a basis for case management decisions determining additionalcontacts and interventions.

The invention will be illustrated in more detail with reference to thefollowing Examples, but it should be understood that the presentinvention is not deemed to be limited thereto.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring to the drawings, wherein the same reference numerals are usedto designate the same elements throughout, there is shown in FIG. 1 ablock diagram representation of a user monitoring system 100 inaccordance with a preferred embodiment of the present invention. Themonitoring system may be used to monitor and assist elderly persons,functionally impaired persons or the like on a temporary short-termbasis or on a long-term basis. The user monitoring system 100 includes amicroprocessor based system controller device 110 linked to varioussensors which are provided within a number of activity detectionsubsystems 112-128. Activity detection subsystems 112-123 are adapted tomonitor various activities of daily living of the user of the monitoringsystem 100. Also included are the in-home telephone 132 which is locatedwithin the user living area being monitored and an outside telephoneline 144.

Any number of daily living activity detection subsystems may be providedwithin the user monitoring system 100 of the present invention. Thedetection subsystems provided in one embodiment may include a movementdetection subsystem 112, a medication self-management detectionsubsystem 116, and a stove safety detection subsystem 120. However, itwill be understood that using differing types of monitors, any otheractivities of daily living may be sensed and detected within usermonitoring system 100. Additionally, the user monitoring system 100 maybe coupled to a computer based case monitoring system 148 by way of atelephone line 144. Formal and informal care givers may be provided withinformation to determine whether short and long term intervention isrequired using the data transmitted to the case monitoring system 148.It will be understood that in addition to telephone line 144 orinteractive television, any method of transmitting messages to system148 may be used. For example, messages may be transmitted by an add-onfiber optic cable box or a portable transmitter.

The user monitoring system 100 integrates sensor data from differentactivity domains to make a number of determinations at predeterminedtimes on a twenty-four hour basis. One activity domain determinationwithin the user monitoring system 100 includes movement of the personbeing monitored. In this movement domain determinations are made by themovement detection subsystem 112 whether the user is up and around. Thedetection information which results from this determination by movementdetection subsystem 112 is transmitted to the system controller device110.

Another activity domain determination within the user monitoring system100 is a determination of medication self-management. In this activitydomain determinations are made whether the user is following apredetermined medication regimen. This determination is made by themedication self-management detection subsystem 116 of the usermonitoring system 100. The detection information which results of thisdetermination by medication self-management system 116 is alsotransmitted to the system controller device 110.

Stove usage is another activity domain which is monitored by the usermonitoring system 100. In this activity domain determinations are madeas to whether a stove has been left on inappropriately. Detectioninformation in accordance with this determination is transmitted to thesystem controller device 110. This determination may be made bydiffering embodiments of the stove safety detection subsystem 120depending on whether the stove being monitored by detection subsystem120 is a gas stove or an electric stove.

In the preferred embodiment of the user monitoring system 100 it is alsopossible to monitor and control other designated appliances using one ormore auxiliary systems subsystems 128. These auxiliary systems mayinclude, for example, other potentially harmful appliances such as ironsor electric space heaters. System controller device 110 also receivesdetection information representative of the determination of thedetection subsystems 116, 128.

Referring to FIG. 2, there is shown a more detailed block diagramrepresentation of the system controller device 110 of the usermonitoring system 100. The system controller device 110 includes acomputer 208 and a radio frequency multichannel receiver 212. Thecomputer 208 may be any type of computer capable of running C++ or anysimilar functionally equivalent object code. The various channels of theradio frequency receiver 212 are provided within system controllerdevice 110 for receiving radio frequency signals transmitted from thevarious detection subsystems 112-128 by way of detection system antennasprovided within the various detection subsystems 112-128. It will beunderstood that a sufficient number of information channels required toaccommodate the number of detectors should be provided within system100. These communication channels may be provided, for example, by anumber of radio frequency channels within radio frequency receiver 212.

The various channels of the radio frequency receiver 212 thus serve asdetection information channels for receiving detection informationwithin the monitoring system 100. However, it will be understood thatany information channel or information conduit or means for applyinginformation may be used to apply information from detection subsystems112-128 to system controller 110. The system controller device 110 isalso provided with an AC power line transmitter 202 for applying controlsignals to the various detection subsystems 112-128 and to the remotemonitoring site 148. Additionally, a system controller modem 204, and atelephone interfacing circuit 202 are present within the systemcontroller 110.

In the preferred embodiment of the user monitoring system 100 the systemcontroller device 110 may also be provided with a voice data storagedevice 210. The voice data storage device 210 may be used within theuser monitoring system 100 to store various audio reminder and inquirymessages which may be provided to the user being monitored atpredetermined times.

The power supply of the system controller device 110 of the usermonitoring system 100 may include a well regulated battery with abattery backup to prevent loss of valuable user data stored in the usermonitoring system 100. The radio frequency multichannel receiver 212 ofthe system controller device 110 is a conventional multichannel radiofrequency device having appropriate anti-interference technology forpreventing interference between the various subsystem channels andinterference from external sources. The anti-interference technology maybe, for example, broad spectrum modulation.

In the preferred embodiment of the system controller device 110 theradio frequency receiver 212 may be a pulsed radio frequency device. Thepower line transmitter 202 of the system controller device 110 is aconventional system for turning controlled appliances on and off. In thepreferred embodiment of the user monitoring system 100, this control maybe accomplished by sending pulsed radio frequency signals through the AClines of the living areas of the user as understood by those skilled inthe art. The use of different pulsed signals, decodable by differentdetection subsystems, is effective to provide any required number ofcontrol information channels for applying control signals to detectionsubsystems 112-128 by system controller 110. However, it will beunderstood that the transmission of control information from the systemcontroller device 110 to the various detection subsystems 112-128 may beperformed by any suitable information channels.

The controller modem 204 of the system controller device 110 may be aconventional modem capable of providing known incoming and outgoingmodem protocols. The outgoing protocols of the controller modem 204 maybe used for data transfer from the system controller device 110 to thecase monitoring site 148 or to other locations by way of telephone line144. The incoming protocols of the system controller modem 204 may beused for reprogramming various monitoring and intervention parameters ofthe user monitoring system 100. Reprogramming may be performed either bythe remote case monitoring site 148 through the controller modem 204 ordirectly to the system controller device 110. Additionally, the incomingprotocols may be used for any type of communication with the usermonitoring system 100.

The local telephone interface circuit 206 of the system controllerdevice 110 provides several functions within the user monitoring system100. It transmits incoming calls received by the user monitoring system100 by way of the telephone line 144 to the in-home telephone 132. Thetelephone interface device 206 also connects ringing voltage as well assynthesized voice messages from the voice data storage device 210 to thein-house telephone 132 on command to provide messages to the user by wayof the in-home telephone 132. It also makes several determinationsregarding the state of the in-house telephone 132. For example,determinations when the in-home telephone 132 is off-hook, when thein-home telephone 132 is not off-hook, and whether the number one hasbeen pressed on the in-home telephone 132 may be made by the localtelephone interface circuit 206.

The user monitoring system 100 operates in a home mode and in an awaymode. The away mode of the user monitoring system 100 may be selected bypressing a dedicated away switch (not shown) located in a convenientlocation in the home of the user. Additionally, the away mode of usermonitoring system 100 may be remotely set from the case managementmonitoring host site 148. The home mode of the user monitoring system100 may be passively set, for example, by the opening of a door when theuser returns home.

In the preferred embodiment of the system controller device 110, areprogrammable microprocessor receives detection information, makesdeterminations as set forth herein, and provides control informationaccordingly. However, it will be understood by those skilled in the artthat any type of control circuitry capable of performing the operationsset forth herein may be used within the user monitoring system 100.

Referring to FIG. 3, there is shown a block diagram representation of apreferred embodiment of the movement activity detection subsystem 112 ofthe user monitoring system 100. Within the user monitoring system 100,movement sensed by the movement activity detection subsystem 112 isassumed to indicate that the user being monitored is up and around.

It will be understood by those skilled in the art that the configurationof the movement detection subsystem 112 may vary according to thediffering living areas being monitored by user monitoring system 100.However, in general the movement detection subsystem 112 includes atleast one and preferably several motion sensors such as motion sensor304 positioned at spaced locations within the home of the user or aconventional reed switch door opening such as sensor detector 308. Themotion sensor 304 and the reed switch 308 are provided for determiningwhether there is movement or activity within the living area beingmonitored by the user monitoring system 100.

In the most basic embodiment of the detection subsystem 112, only asingle motion sensor 304 may be provided. In this case the single motionsensor 304 is preferably placed between the bed of the user and thebathroom. In a case where only a single reed switch is provided withinthe movement detection subsystem 112, it is preferably placed on thedoor of the bathroom. Such basic configurations of the movementdetection subsystem 116 are effective to determine whether the userbeing monitored has gotten out of bed or has gone to the bathroom aftera predetermined time.

When an activity is sensed by the motion sensor 304 or the door openingsensor 308, a motion transmitter 306 of the motion detection subsystem112 transmits a radio frequency signal by way of the motion antenna 302.This motion signal representing an activity of daily living by the useris received by the system controller device 110 of the user monitoringsystem 100. It is therefore activity of daily living information whichindicates that the detected user movement has occurred within the homebeing monitored by the user monitoring system 100.

Similarly, a conventional reed switch (not shown) or other type ofswitch within the door opening sensor 308 is provided with a radiofrequency door opening transmitter 312. The door opening transmitter 312transmits a door opening signal indicating the opening of a door orcabinet to which the sensor 308 is applied. The door opening signal istransmitted by detection subsystem 112 is a radio frequency signalrepresentative of this activity. It is transmitted to the systemcontroller device 110 by way of the motion detection antenna 310.

If the dwelling being monitored is large or complex a more elaborateconfiguration of movement and activity sensors 304, 308 may be requiredwithin the movement detection subsystem 112 of the user monitoringsystem 100. However, in the preferred embodiment of the user monitoringsystem 100 at least movement from the bed and movement into and out ofthe bathroom should be monitored by the movement detection subsystem112. Inappropriate periods of user inactivity as indicated by sensors304, 308 or other sensor disposed in these locations may indicate amedical emergency. It will be understood that a plurality of motionsensors or switches such as reed switches may be placed in locationswithin the living area being monitored and that there are no theoreticallimitations in the number of such devices which may be used with themovement detection system 112.

When the movement detection subsystem 112 operates in the home mode theuser monitoring system 100 is in a twenty-four hour cycle. Thistwenty-four hour cycle includes information with respect to the usualwaking time of the user being monitored. Using the motion sensors 304,308 of the motion detection subsystem 112 the user monitoring system 100determines if the user remains in bed a specified length of time beyondthe usual waking time or has not gone from the bed to the bathroom for apredetermined time period. If the user monitoring system 100 determinesan abnormal lack of user activity such as this it may enter a wake upmonitor phase.

In the wake up monitor phase of the user monitoring system 100 thesystem controller device 110 may place a telephone call to the user byway of the telephone 132 in order to determine whether the user ishaving a problem. If the telephone call placed by the system controllerdevice 110 is answered, the user is prompted by the system controllerdevice 110 to depress a predetermined key on the in-home telephone 132.For example, the user may be prompted to press the telephone keyindicating the number one. If the user complies with the prompt from thesystem controller device 110 the wake up monitor phase of the usermonitoring system 100 is complete. If there is no answer to the callplaced by the system controller device 110 and the user monitoringsystem 100 is not in away mode, or if the user answers the telephone butdoes not depress the requested key, the user monitoring system 100contacts the case monitoring site 148 with an immediate status reportindicating a potential problem with the user.

Assuming all is well, the activity movement detection subsystem 112 ofthe user monitoring system 100 merely monitors all system status changeswithin system 100. This includes monitoring and storing information fromthe motion detectors 304, 308 representing movement and the opening andclosing of doors, the usage of medication, the usage of the stove andappliances, and any other auxiliary devices which maybe monitored by theuser monitoring system 100.

Each status change detected by the user monitoring system 100 is assumedto indicate activity of the user being monitored. In the event of thedetection of a period of inactivity in excess of a predetermined amountof time during the usual waking hours of the user, the user monitoringsystem 100 returns to the wake up monitor phase and places a telephonecall to the user as previously described. The period of inactivityrequired for the user monitoring system 100 to return to the wake upmonitor phase is adjustable depending upon the habits of a particularuser but may, for example, be two and one-half hours.

When the user monitoring system 100 is in the away mode it does notrecord or report any activities. It merely waits for active or passiveresetting of the home mode as previously described Active resetting ofthe home mode of the user monitoring system 100 occurs when the useractivates a dedicated home/away switch which may be mounted at anyconvenient location. Passive resetting of the mode of the usermonitoring system 100 may occur when the user returns and changes thestatus of any detection subsystem 112-128.

Referring to FIGS. 4A, B, and 5, there are shown a side view, a top planview, and a schematic representation of a preferred embodiment of themedication self-management detection subsystem 116 of the usermonitoring system 100 of the present invention. The medicationself-management detection subsystem 116 comprises a medication holder404 which is a specialized portable holder or caddy for holding at leastone medication container 402 in a corresponding container opening 404.

In the preferred embodiment of the medication detection subsystem 116 aplurality of the medication containers 402 may be installed within theircorresponding container openings 406 in the portable medication holder404 when the user being monitored is not removing medication from them.The medication containers 402 and the container openings 406 within themedication holder 404 maybe color coded. In this method the colors of aselected medication container 402 and its container opening 406 matcheach other. Likewise, each container opening 406 of the medicationholder 404 may be provided with a matching colored light 408. Thecolored lights 408 assist the user in returning a removed medicationcontainer 402 to its correct container opening 406.

When a medication container 402 is disposed within a container opening406 of the medication holder 404 the medication container 402 closes aconventional normally open switch 416. When the medication container 402is removed from the opening 406 of the medication holder 404 it releasesthe normally open switch 416 causing it to open. When a switch 416within the medication holder 404 is opened or closed in this manner by amedication container 402 a radio frequency medication transmitter 424 isactivated. In this manner the medication self-management detectionsystem 116 communicates this activity of daily living information withthe system controller device 110.

The radio frequency signal provided by the medication transmitter 424when it is activated by a switch 416 is pulse code modulated by pulsecoder 420. The modulating of the pulse coder 420 is performed in aseries of differing manners according to which switch 416 within themedication container 404 is opened. The selected pulse coded signal fromthe medication transmitter 424 is received, decoded, and stored by thesystem controller device 110 of the user monitoring system 100.

While the medication container 402 is removed from the medication holder404 its matching colored light 408 is activated. This causes the colorcode of the medication container 402 removed from the medication holder404 to be displayed as previously described. When the medicationcontainer 402 is replaced in its opening 406 of the medication holder404 and the transmitter 424 is activated to transmit a correspondingpulse code modulated signal, the colored light 408 turns off and thetransmission from the medication transmitter 424 to the systemcontroller device 110 terminates. The termination of the transmission bythe medication transmitter 424 indicates to the system controller device110 that the medication container 402 has been returned to its opening406 in the medication holder 404.

It will be understood by those skilled in the art that any number ofmedication openings 406 may be provided within a container holder 404 ofthe medication self-management detection subsystem 116. However, it isbelieved from current research that the daily medication managementneeds of a majority of users of the user monitoring system 100 may bemet by eight medication openings 406 and eight corresponding medicationcontainers 402 although only three are shown in order to simplify thedrawings. It will also be understood that the openings 406 of thecontainer holder 404 and the medication containers 402 may be providedwith keying features so that only the correct medication container 402may be placed into an opening 406 of the medication holder 404.

While the above describes many of the features of a preferred embodimentof the medication self-management detection system 116, it should benoted that various arrangements of medication holders and dispensers maybe used. For example, the medications within a medication holder 404 maybe organized according to the time of day they are taken. In this typeof organization medications which are taken at the same time may beloaded together into a single compartment within the medication holder404. A plurality of these compartments may be provided within themedication self-management detection system 116. The opening and closingof these compartments may be monitored by the medication self-managementdetection system 116 in substantially the same manner as previouslydescribed with respect to monitoring the removal of the medicationcontainers 402 from the openings of the medication holder 404.

As previously described the pulsed transmissions from the medicationtransmitter 424 to the system controller device 110 may carry aplurality of differing codes corresponding to the plurality of differingmedication containers 402. Each pulse code corresponds to an individualmedication container 402 and indicates when its corresponding medicationcontainer 402 is currently removed from the medication holder 404.

The system controller device 110 of the user monitoring system 100 isprogrammed to record the times of removal and replacement of eachmedication container 402 within medicine holder 404 according to thesetransmissions. It is also programmed to determine scheduled on-timeremovals of each of the medication containers 404 from the medicineholder 404. Compliance data representative of these determinationsaccording to transmissions from the medication self-management detectionsystem 116 may be transferred to the case monitoring site 148 forintervention decisions.

The system controller device 110 of the user monitoring system 100 maybe programmed to determine when user compliance does not conform to ascheduled regimen. After a selected time period, for example, one-halfhour, without user compliance, voice data from the voice data storagedevice 224 may be applied by the controller device 110 to the in-hometelephone 132 to remind the user to take medications. The systemcontroller device 110 may also provide general and specific remindersand inquiries to the user concerning medications after the user returnsfrom being away. These reminders and inquiries may be made with respectto all medications or with respect to specific medications. The systemcontroller device 110 may also provide specific time scheduled remindersto take medication.

Referring to FIGS. 6, 7, there are shown two embodiments of the stovesafety detection subsystem 120, the stove safety detection subsystem 600and an electric stove safety detection subsystem 700. The stove safetydetection systems 600, 700 of FIGS. 6, 7 are preferred alternateembodiments which are adapted for monitoring and controlling gas stovesand electric stoves, respectively.

The stove safety detection subsystems 600, 700 of the user monitoringsystem 100 each include an appropriate stove-in-use sensor fordetermining when a monitored stove is turned on. Each stove safetydetection subsystem 600, 700 also includes an appropriate shut-offreceiver unit for receiving a radio frequency transmission from thesystem controller device 110 by way of the AC lines to turn themonitored stove off and protect the user. The stove-in-use sensors ofthe stove safety detection subsystems 600, 700 continuously provideinformation to the system controller device 110 of the user monitoringsystem 100 regarding whether the monitored stove is currently on.

The stove-in-use sensor 604 of the gas stove safety detection subsystem600 is a gas flow monitor 604. The gas flow monitor 604 is disposed inthe gas line 602 which supplies gas to the gas stove 610 in order tomonitor the gas supplied by the gas line 602 to the gas stove 610. Gasflow information from the gas flow monitor 604 is pulse coded by a pulsecoder 612. The coded signal from the pulse coder 612 is transmitted tothe system controller device 110 by a gas stove transmitter 620 by wayof the gas stove antenna 616.

The system controller device 110 may determine that the gas stove 610must be shut off in accordance with the coded information from the gasflow monitor 604. If this determination is made by the system controllerdevice, it applies a control signal to the gas stove safety detectionsubsystem 600 by way of the AC line 630. The control signal to the gasstove detection system 600 from the system controller device 110 isgenerated and transmitted by way of the AC power line transmitter 216 aspreviously described. This control signal is received by the controllerreceiver 628 of the gas stove safety detection subsystem 600. Thecontroller receiver 628 instructs a gas shut off valve 608 by way of astep down circuit 608 to terminate gas flow through gas line 602 to thegas stove 610 in response to the control signal. This turns off the gasstove 610.

When the user monitoring system 100 monitors an electric stove 710, anelectrical current draw monitoring device 704 is provided for use alongwith the electric stove safety detection system 700. The electricalcurrent monitoring device 704 is applied to the AC power line 706 whichsupplies power to the electrical stove 710. By monitoring the AC powerline 706 detector subsystem 700 is able to indicate the on/off status ofthe burners of the electric stove 710. On/off status information iscoded by the pulse coder 712 and transmitted by an electric stovetransmitter 720 by way of antenna 716 to the system controller device110.

The system controller device 110 may determine that the electric stove710 must be shut off in accordance with the coded information from thecurrent draw monitor 704 as previously described with respect to the gasstove safety detection system 600. If electric stove 710 is to be shutoff, the system controller device 110 applies a control signal to theelectric stove safety detection subsystem 700 by way of the AC line 730.This signal is received by a controller receiver 728 of the electricstove safety detection subsystem 700. The controller receiver 728instructs the electrical trip relay 708 to interrupt electricity throughthe electrical power supply line 702 to electrical stove 710. This turnselectric stove 710 off.

When the stove safety detection subsystems 600, 700 provide informationindicating that a stove is on, shut down predetermined controlalgorithms are followed in order to determine whether the stove 610, 710should be turned off. These predetermined control algorithms areexecuted within the system controller device 110 of the user monitoringsystem 100. In the preferred embodiment of the user monitoring system100 the algorithms operate upon coded information transmitted from thestove safety detection management subsystems 600, 700 and the movementdetection subsystem 112 in the following manner although the otheralgorithms may be used if desired:

If (no movement detected for 30 minutes) or (away-mode status) andstove-on status), then (call with stove reminder).

If (no answer to call), then initiate shut down and record event. If(call is answered and 1 is pressed), override shut down.

If (stove on status) and (smoke detector tripped), then initiate shutdown and record event.

If (stove is on for [X] minutes), then alert remote site host withautomated telephone message: “Your stove is on, do you want it on? Ifyes, press 1; otherwise, it will be turned off.” Answering the telephoneand pressing 1 override the shutdown sequence.

Additionally, management subsystems 600, 700 may include smoke detectorsensor devices 632, 732 coupled to radio frequency transmitters 620,720. The smoke detection sensor devices 632, 732 may be standard opticalsmoke detector modified to include a subsystem switching circuit (notshown) which is effective to provide a smoke detect control signal whensmoke is detected by the sensor devices 632, 732. The radio frequencytransmitters 620, 720 of the smoke detection subsystem is coupled to thesystem switching circuit of the smoke detection sensor devices 632, 732in a manner well understood by those skilled in the art.

When the sensor devices 632, 732 detect smoke within the home of theuser they sound a fire alarm in a conventional manner. Additionally, thedetection of smoke by the sensor devices 632, 732 activates subsystemswitching circuit which activates the respective smoke detectortransmitter 620, 720. In response the smoke detection transmitters 620,720 provide a pulsed radio frequency control signal by way of theantenna 616. This control signal conveys information to the systemcontroller device 110 of the user monitoring system 100. The informationtransmitted by the subsystems 600, 700 in this manner indicates to thesystem controller device 110 that smoke was detected by a sensor device632, 732. It may also indicate which particular sensor device istriggered if more than one sensor device 632, 732 is used within asubsystem 600, 700.

Referring to FIG. 8, there is shown a more detailed schematicrepresentation of the current draw monitor 704 of the electric stovedetection subsystem 700. The current drain monitor 704 may include apassive clamp coil 730 disposed around the electrical supply line 706which applies electrical energy to the electric stove 710.Electromagnetic fields arising from the current applied to the stove 710by way of the electrical supply line 706 thus induce current in thepassive clamp coil 730. The current induced in the passive clamp coil730 may be rectified by a bridge rectifier 734, amplified by anamplifier 738, and applied to a diode switch 742. The diode switch 742may then control the gate of silicon control regulator 746 to applyenergy to the pulse coder 712.

It will be understood that any method may be used for sensing theelectromagnetic fields arising from the current applied to the stove byway of the electrical supply line which induces current in the passiveclamp coil 730, provided the current induced in the passive clamp coilis used to toggle an electronic switch of suitable design to control apulsed radio frequency signal indicating to the system controller theon/off state of the stove 710. Additionally, it will be understood bythose skilled in the art that pulse code 710 may be controlled by anyother means for determining the state of stove 710.

Referring to FIG. 9, there is shown a preferred embodiment of the wateroverflow detection subsystem 124 of the user monitoring system 100. Thewater overflow detection subsystem 124 may be installed on plumbingfixtures such as sinks and bathtubs within the home of the user beingmonitored by the user monitoring system 100. Within the water overflowdetection subsystem 124 a water level sensing device 1004 and a remotecontrolled shut-off device 1030 are provided in communication with thesystem controller device 110 of the user monitoring system 100.

In the principles of its operation, the water overflow detectionsubsystem 124 is similar to the gas stove safety subsystem 600previously described. The water level sensing device 1004 or water levelmonitor 1004 sends information to the system controller device 110 bymeans of a pulsed radio frequency water level transmitter 1002. Thesystem controller device 110 is programmed to initiate shut off of waterwithin overflow detection subsystem 124 by means of a radio frequencyremote control signal. The radio frequency remote control signal istransmitted through the home of the user by way of the AC lines.

The control signal from the system controller device 110 is received bythe controller receiver 1044, stepped down by step down circuit 1040.The stepped down signal is used to control resetable electricallycontrolled water valves 1034, 1038. The electrically controlled valve1034 may control water flow from an inlet pipe 1026 to a tub supply pipe1028. The electronically controlled valve 1038 may control water flowfrom an inlet pipe 1026 to a sink inlet pipe 1032.

The water level sensing device 1004 includes two water level detectors1006, 1012, and a siren module 1018 having a conventional timer. A sirentransducer such as a piezoelectric crystal is also provided. Athree-state pulsed radio frequency transmitter 1002 may be providedwithin the water overflow detection subsystem 124.

When water is sensed at a warning level by the level detector 1006 thesystem controller device 110 of the user monitoring system 100 isinformed that water is approaching the warning level mark. When this isdetected the user monitoring system 100 calls the user on the in-hometelephone 132 in order to provide a reminder. When the level detector1012 determines that the water level has approached the high water mark,the siren 1024 sounds. Additionally, the received radio frequency pulsedata informs the system controller device 110 of the user monitoringsystem 100 to turn the water off. This event is logged within the systemcontroller device 110. The water overflow detection subsystem 124 may beprogrammed to permit resetting of the valves 1034, 1038 in response tocommands from within user monitoring system 100 or from the casemonitoring site 148.

Referring to FIG. 10, there is shown a block diagram representation ofthe auxiliary appliance detection subsystem 128 of the user monitoringsystem 100. The auxiliary appliance detection subsystem 128 providesadditional channels to the user monitoring system 100 for monitoring andcontrolling further appliances 1116 or devices 1116.

The on/off state of the further device 1116 is monitored and transmittedto the system controller device 110 of the user monitoring system 100 bymeans of a current draw detector 1108. The current draw detector 1108monitors current applied to the device 1116 by way of the AC powersupply line 1114. The current draw detector 1108 is coupled to a radiofrequency auxiliary transmitter 1112 which transmits a two state signalrepresenting on and off. This information may be used by the systemcontroller device 110 both for status change data and for generating adaily activity data log. The current draw sensor 1108 of the auxiliarydetection subsystem 128 should be sufficiently sensitive to distinguishbetween trickle draw and operational power when auxiliary device 1116 isa solid state device such as a television or a clock radio.

In addition to the monitoring of the use of a auxiliary device 1116,automatic remote control of the device 1116 may be accomplished. Thesystem controller device 110 of the user monitoring system 100 may beprogrammed to control a controlled outlet or receptacle adapter whichapplies energy to the AC line 1114. This control may be exercised atpredetermined times of the day or upon certain environmentaloccurrences. For example, when the user monitoring system 100 is in theaway mode this feature may be used to automatically turn the auxiliaryappliance 1116 off. More than one auxiliary subsystem 128 may beprovided within the user monitoring system 100.

Furthermore, monitoring system 100 may be provided with an auxiliarydetection system which is not monitored by a current draw monitor 1108or controller receiver 1104. For example, the multichannel receiver 212of system controller 110 may be used to monitor smoke detectionsubsystem 900 shown in FIG. 9.

It will be understood that many differing combinations of auxiliarydetection subsystems may be provided within the user monitoring system100 of the present invention. It will also be understood that thesecombinations may be used in combination with automated dialing systemsat other locations. Automated dialing systems which may call thedwellings of various users, for example, one or more times a day havebeen developed. This provides the user with an opportunity to return apredetermined signal if there are no problems and return a differentpredetermined signal or no signal if there are problems.

These services may give users up to six automated contacts per day. Forexample, an automated dialing system for providing medication compliancereminders, suitable for use with the user monitoring system 100, hasbeen field tested. In this automated reminder system users were calleddaily and reminded to follow their medication regimen.

Referring to FIGS. 11A-11M, there are shown flow chart representationsof the operations of the various subsystems of the user monitor system100. FIG. 11A is a flow chart representation of a method for determiningwhich of the various subsystems has initiated an event for processing bythe controller 110. FIG. 11B is a flow chart representation of a methodfor determining whether the user has arisen by a designated wake uptime. This method may be performed in response, for example, to a signalfrom the motion sensor 304. FIG. 11C is a representation of a method fordetermining whether the user is complying with the medication scheduleas indicated by the subsystem 116.

FIG. 11D is a representation of methods for determining whether a stovehas been left on according to the subsystem 600 and whether the smokedetector 732 has been activated. FIG. 11E is a flow chart representationof a method for turning off the stove 610, 710. FIG. 11F is a flow chartrepresentation of a method for controlling water flow according to thesubsystem 124. A pseudocode representation of a method for controllingwater flow is set forth in Table I.

1 TABLE I Is there a flow If yes Is there a change of state If yes sendevent to main controller If no recycle to flow monitor If no Is there achange of state If yes send event to main controller If no recycle toflow monitor Is there water overflow If yes Send event to maincontroller If no Is there water warning If yes send event to maincontroller If no recycle to water overflow.

FIG. 11G is a flow chart representation of a method for alerting a userthat an appliance has been left on, for example, in accordance with thebridge rectifier 734.

FIG. 11H shows a method for calling a designated party when an alert hasbeen determined. FIG. 11I shows a method for recording the detection ofmovement, for example, in response to a signal from the motion sensor304.

FIG. 11J is a flow chart representation of a method for reading switcheswithin the user monitoring system 100. A pseudocode representation of amethod for reading switches is set forth in Table II.

2 TABLE II Is the switch open If yes Is there a state change If yes sendevent to controller turn off light If no recycle to open test If no Isthere a state change If yes send event to main controller turn on lightIf no recycle to open test.

FIG. 11K is a flow chart representation of an algorithm for determiningeither current flow or gas flow. FIG. 11L is a flow chart representationof an algorithm for detecting water overflow. FIG. 11M is a flow chartrepresentation of an algorithm for controlling an auxiliary appliance. Apseudocode representation of this method is set forth in Table III.

3 TABLE III Is the automatic timer set If yes Is there current draw Ifyes Is turn off timer exceeded If yes turn off appliance send event tocontroller If no recycle to AT set If no Is turn on time exceeded If yesturn on appliance send event to controller If no recycle to AT set If noIs there current draw If yes Is there a state change If yes send eventto main controller If no recycle to AT set If no Is there a state changeIf yes send event to main controller If no recycle to AT set.

As previously described, using the microprocessor based systemcontroller device 110 and a system of sensors the user monitoring system100 can determine, for example, whether users are up and about in theirhomes and whether they are having difficulty managing their medications.It can also be determined whether the user has accidentally left a stoveon or has failed to get out of bed a predetermined number of hours aftera usual waking time. If the user monitoring system 100 detects any ofthese or other problems it can then call the user on the in-hometelephone 132 to provide a reminder about the medications, stove, orother detected problems.

Using this data from the user monitoring system 100, the remote casemonitoring system 148 may provide on-line case monitoring of each userby receiving standard information and information designated as priorityinformation and analyzing the received information. In order to do this,the remote case monitoring system 148 converts incoming data on eachuser into various summary reports which track the activities of theclient. This makes it possible to distribute specialized gerontologicalevery day living summary reports to users, family members, casemanagers, physicians and others. It also makes it possible to collectand act upon the designated priority information which may indicateimmediate problems for the user. For example when a user appears not tohave gotten out of bed a problem may be indicated.

Additionally, the collection of this kind of data by the remote casemonitoring system 148 may provide an aggregate data base for identifyingwhich users require personal interventions and which do not. In order toperform these functions the remote case monitoring system 148 serves asa central hub for the collection, analysis and exchange of informationwhich has direct case management import. It should be understood that indifferent embodiments of the inventive concept different degrees ofautonomy of the local system controller 110 in relation to the remotesystem 148 are possible. In one embodiment a local system controller 110may be programmed to perform many functions performed by the remote casemonitoring system 148 in another embodiment.

For example the dialing and sending of voice messages to a list ofrelatives and providers may be performed either by the local systemcontroller 110 or the remote case monitoring system 148. However, itwill be understood that the primary function of the local systemcontroller 110 is to provide lower level case management of localobservations and decisions and the primary function of the remote casemonitoring system 148 is to provide higher level case management toenable long term interpretation of the data obtained from the usermonitor system 100 and intervention in view of the long-terminterpretation.

Thus in the preferred embodiment of the present invention, the usermonitoring system 100 or the remote case management system 148 may useits electronic records to enable the production of scheduled periodicuser activity reports based upon information gathered by the varioussubsystems of the user monitoring system 100. These periodic reports mayinclude collections, compilations and arrangements of information on anyor all of the monitored activities within the user's living area. Theseelectronic records may be used in combination with any other informationto produce any type of periodic activity reports desired on the userbeing monitored. These user activity reports may be used by aprofessional case manager or a designated family member to determine ifthe user is experiencing problems with specific activities of dailyliving. Thus these problems may be dealt with before they become athreat to the continued well being of the user and the ability of theuser to live independently.

Furthermore, in addition to providing remote case monitoring and in-homereminders, the user monitoring system 100 may be programmed to takecorrective actions when certain problems are detected. For example, ifthe user being monitored has not gotten out of bed by a predeterminedtime the user monitoring system 100 may call the user on the telephone132. If there is no answer to the telephone call the user monitoringsystem 100 may be programmed to automatically transmit this informationto the remote case monitoring site 148.

A social worker, health professional or designated family member at theremote case monitoring site 148 may respond to the transmittedinformation according to a predetermined protocol. In addition totransmitting the information to the remote case monitoring site 148 theuser monitoring system 100 may provide control signals within the homeof the user. For example, if the user monitoring system 100 of thepresent invention determines that a stove has been left on, the usermonitoring system 100 itself can turn off the stove.

The remote case monitoring system 148, in association with the usermonitoring system 100, may serve the functions of a case managementsite. In an example of the case management site function of the remotecase monitoring system 148 the case management site may monitorapproximately fifty distributed clients, each using a distributed userelectronic monitoring system 100. The fifty clients thus have the systemcontroller 110 and various subsystem sensors installed in theirdwellings in ways appropriate for the specific configuration of theirliving areas. For example, the various subsystem sensors must be adaptedfor different floor plans and furniture arrangements.

The remote case monitoring system 148 may receive information from thedistributed user monitoring systems 100 on an immediate basis or atpredetermined time intervals. For example, the remote case monitoringsystem 148 may receive information hourly, daily or weekly basis. If oneof the clients does not get out of bed within a predetermined timeduration and does not answer the telephone, the local system controller110 of the user monitoring system 100 at that client's house may callthe case management site. At the case management site, this event may bebrought to the immediate attention of the human case monitor, forexample, by means of a computer screen. The remote case manager mayexamine individual: case and data records for the client being monitoredto learn the predetermined response for the monitored person when thereported event occurs.

Likely interventions required of personnel at the case management sitemay include calling a local case manager, a hospital social worker or alocal next of kin. Other actions the remote case monitor may executeinclude calling the user, remotely downloading the last twenty-four orforty-eight hours worth of event summary information from the local usermonitoring system 100 and remotely initiating a diagnostic sequence onthe local user monitoring system 100.

The protocol of procedures for intervention by the remote case monitor148 may differ from one remote case monitoring system 148 to another andfrom one user to another. It is anticipated in the preferred embodimentof the invention that various intervention decisions such as who to callwhen predetermined events occur and what messages to deliver may becarried out by a machine intelligence expert system (not shown) at theremote case monitoring system 148 or by a person or a combination ofboth. The local user monitoring system 100 may also be programmed tocarry out such decisions as who to call when appropriate. For example,the user monitoring system 100 may have a contact list of people tocontact in various emergencies.

In addition to receiving and interpreting data indicating the need forintervention in event of emergencies, the remote case monitoring system148 routinely receives downloaded data from individual user monitoringsystems 100 at predetermined intervals. This data is interpreted on theindividual and aggregate level by means of trend analysis software whichdetects larger than statistically normal deviations from event patternmeasurements. The remote case monitoring system 148 may use thisanalysis to produce periodic summary reports of events relating toeveryday living tasks in the home environment of the user. Morespecifically these reports may be used to detect certain event classes,to weight them in terms of their relative importance and to compare themwith baselines of task performance. The events weighed with respect totheir importance may include getting out of bed, managing medication,the proper control of a stove, the proper control of water flow, and theproper control of selected electrical appliances. Based upon the reportsof these events, gerontological living summary reports may be preparedin machine form and paper form at the remote case management system 148for distribution to predesignated parties involved in the casemanagement of the user of the user monitoring system 100. These partiesmay include the users themselves, relatives of the user, case managersocial workers, physicians and other appropriate formal and informalproviders.

Two additional functions of the remote case monitoring system 148 may beprovided. These functions are: (1) the remote programming andreprogramming of the user monitoring system 100, and (2) the generationof aggregate and individual level data on relatively large numbers ofusers. This data may serve both as an empirically grounded knowledgebase driving the decision protocols for both humans and machines as wellas research data for further development of the user monitoring system100.

In order for these functions to be performed data must be transmittedbetween the user monitoring system 100 and the remote case monitoringsystem 148. Information transmitted to the system controller 110 of thelocal user monitoring system 100 from the remote case monitoring system148 may include three different types of commands: queries, diagnosticsand settings. The query commands request the downloading of specificinformation from the memory of the user monitoring system 100 to theremote case monitoring system 148. The requested information forms thebasis of the gerontological everyday living events report along withspecific information necessary for case monitoring by the remote system148. For example the status of different subsystems of the usermonitoring system 100 might be made available to the remote system 148when the motion subsystem 112 indicates that the user has not gotten upin the morning.

The diagnostic commands to the local user monitoring system 100 test thedifferent subsystems of the system 100 by suppressing the ability of thesystem 100 to either call out interventions or change settings on any ofthe remotely controlled devices while at the same time initiating asequence of event codes which indicate the presence of various kinds ofproblems as if they were indicated by the different subsystems.

The setting commands from the remote case management system 148 to theuser monitoring system 100 reset the parameters on the timers within theuser monitoring system 100 as well as other variable values for thedecisions made in the decision trees described herein below. Theseparameters may include, but are not limited to, the time of waking up,the times for taking different medications and the length of time whichshould elapse prior to turning off the stove.

Transfer information transmitted in the opposite direction, from thesystem controller 110 of the user monitor system 100 to the remote casemonitoring system 148, includes two types: (1) priority specific datatransfer and (2) standard data transfer. Priority specific data transferis initiated by the local system controller 110 by means of dialing theremote case monitoring system 148 by way of the telephone line 144 or bymeans of another data link (not shown) and indicating the presence of aproblem which the remote case monitoring system 148 must detect, recordand act upon.

Situations in which the local system controller 110 dials out to informthe remote case monitoring system 148 that the user did not get out ofbed or that the stove was left on, are potential emergencies and aretherefore examples of priority specific data transfer. Standard datatransfer includes the downloading of event log information for eachsubsystem. This information is used to produce trend analysis reportswhich show the frequency of occurrence of different events over apredetermined time period such as six months. Thus the trend analysisreport might show that over the course of six months the user becameincreasingly noncompliant with medications and/or increasingly likely toleave the stove on inappropriately. Using a known trend analysistechnique, software driven reports can detect increasing frequencies ofproblems of every day activities.

The trend analysis report may be a monthly paper or machine report whichprovides several indicators of performance on different areas ofeveryday living monitored by the user monitoring system 100. These areasmay include waking and sleeping, medication management, stovemanagement, water flow management and the operation of additionalappliances. The raw data for this report is based on the event log datatransferred from the local system controller 110 remote system usingstandard data transfer and priority specific modes. The raw data is usedto provide a continuous baseline of the successful and not successfulcompletion of the five task areas.

For example, in one month a user may use the stove fifty-five times andleave it on in violation of the programmed protocol two times. Themonthly report line for the stove category might then show fifty-fiveuses and two usage errors. Furthermore, usage errors may be classifiedaccording to level of importance by means of a weighting system. Anerror of, for example, skipping one medication may be weighted asconsiderably less significant compared with an error of leaving thestove on and leaving the apartment for several hours. Thus not only areerrors recorded and plotted against continuous baselines overtime in thetrend analysis report of the system of the present invention, but thereport is intended to contain a ranking system to reflect the potentialnegative impacts of different errors.

In addition to errors, the trend analysis report can plot deviations inbehavior indicating changes in plot trend. For example, the trendanalysis report can plot waking and sleeping hours and the number oftimes a user goes to the bathroom. While none of this in itselfindicates a situation requiring intervention, sudden changes in sleephabits, bathroom use, even appliance use may indicate sudden changes inhealth or cognitive well being requiring a relative or a case managementsocial worker or case management social worker or a physician to visitor interview the user.

While any number of combinations of interpreted data can be used in anynumber of specialized reports, it is anticipated that most casemanagement sites and most relatives would want to know the frequency andseverity of specific errors, the extent and accuracy of medicationcompliance and whether a waking or sleeping pattern of a user ischanging radically. The trend analysis report provides case managers andrelatives with this information and enables them to better help the userby locating subtle changes in behavior patterns, monitoring variouskinds of potentially dangerous errors and keeping a record of baselinefunctioning in relation to monitored activities.

While the operation of the monitoring system 100 has been describedprincipally with respect to the monitoring of a gerontological patient,it will be understood that system 100 may be used to monitor any type ofpatient, for example, infants and burn victims. Additionally, it will beunderstood that, using the correct sensors, monitoring system 100 maymonitor any parameters relevant to these patients, for example, ambienttemperature, body temperature and blood pressure. In general, anythingwhich may be sensed by a sensor and converted into an electrical signalmay be monitored by the monitoring system 100. Additionally, the datacould be made available to a doctor prior to routine doctor'sappointments in addition to being used to compile reports at the remotemonitoring site 148. The system could be monitored by a friend orrelative rather than by professionals at a remote monitoring site.

Local microprocessor based system controller 110 and its associatedsystem of sensors can determine any activity of daily living desired.For example, system controller 110 can determine whether users are upand moving around in their homes. Additionally, it can determine, forexample, whether the user is having difficulty managing medications,whether the user has failed to get out of bed a predetermined number ofhours after a usual waking time, and whether the user has left the stoveon. Furthermore, system controller 110 can determine other detectedproblems.

As previously described, various degrees of autonomy of local systemcontroller 110 from remote monitoring system 148 can be obtained invarious embodiments of the invention. Thus, system controller 110 can beprogrammed to perform many functions performed by remote monitoringsystem 148 in other embodiments of the invention. However, it isunderstood that the primary function of local system controller 110 isto provide lower level case management of local observations anddecisions and the primary function of remote monitoring system 148 is toprovide higher level case management and enable long term interpretationof the data.

Using the information sent from local system controller, remote casemonitoring system 148 can provide on-line case monitoring of any numberof users by receiving standard priority information or other informationand analyzing the received information. When performing these operationsremote case monitoring system 148 converts incoming data on each userinto various summary reports which track the activities of theindividual users.

Monitoring and analyzing the received information in this manner makesit possible for remote case monitoring system 148 to distributespecialized everyday living monitoring summaries (ELMS) reports to otherparties. For example, the reports obtained in this manner can bedistributed to family members, doctors, case managers, and others.

The monitoring and analyzing by system controller 110 and remote casemonitoring system 148 also makes it possible to collect action priorityinformation. For example it is possible to determine when users do notget out of bed. In addition it may provide an aggregate data base foridentifying users requiring personal intervention. Additionally, it maybe possible to provide a central hub for the collection and exchange ofinformation with direct case management resources.

Local system controller 110 can be programmed to perform a variety offunctions related to data base report generation and interventiondecisions. In one embodiment of the invention system controller 110 canbe programmed to learn activity patterns of the user. The leaning bysystem controller 110 occurs through analyzing sensor data andperforming a variety of operations that change various parameters of theuser. For example, timing and frequency parameters of expected activityevents can be changed based upon a trend analysis of the past timing,frequency, duration and concomitance of events. The trend analysis canbe based upon an interval of a week, a month, or other time period forwhich data is internally stored.

The learning of user activity patterns by system controller 110 orremote case monitoring system 148 can be accomplished using varioustechniques. In most of these techniques the learning process involvesthe changing of variable values, parameter settings and decisionalgorithms. The quantities changed in this manner are changed withrespect to interpreting data derived by sensors for machine initiatedinterventions and the production of various reports.

The determinations of the system of the present invention are based uponthe assumption that the best predictor of future behavior is pastbehavior and upon the empirical knowledge of the relatively invariantfrequency, timing, and duration of essential activities of daily livingas part of daily and weekly cycles. Using these bases, it is possible touse a variety of methods to determine whether the activities on acertain day fall within or outside of the range of statisticallyexpected occurrences of the activities. In the preferred embodiment, theuser monitoring system uses well known algorithms for analyzingcontinuous baseline data.

Variable values obtained by system controller 110 or remote casemonitoring system 148 can be in the form of time and date stamped eventdata or transformations thereof. For example, the variables can be acount or a weighted frequency of occurrence of a predeterminedmeasurement, such as the number of times within a predetermined timeperiod a medication is taken or a toilet is flushed.

Using programming and statistical techniques well known and understoodby those skilled in the art, system controller 110 can be enabled tolearn the typical timing and frequency of a user taking each prescribedmedication as well as the number of times that a user typically uses thetoilet. Using such techniques it is also possible to learn the typicaltiming and frequency of the user opening and closing the refrigeratordoor, the silverware cabinet, the microwave oven, and the stove, as wellas the typical time of getting out of bed in the morning.

Typical variable values used in the method of the present invention forthe purpose of, for example, report generation and learning, can beunderstood in the common statistical sense of measures of a centraltendency paired with an appropriate measure of dispersion. Themeasurement of the central tendency of sensor events can includemeasurements such as mean, median, and mode. The measure of dispersioncan be measurements such as standard deviation and interquartile range.

There are various techniques for statistically determining a typicalvalue of a measured event and then using this value to predict the valueof future events. A common technique sets the typical value equal to itsmeasure of central tendency bounded by a confidence level (sigma) equalto +/− the appropriate number of dispersion units to account for analpha level of (typically) 0.05. For each measurement within an activityor event domain, these standard statistical procedures apply, especiallyas used in relation to continuous baseline or moving averages. Forexample, motion out of bed, the opening of a refrigerator, or taking amedication, controller system 110 may store this information and compareit with past similar events using well known statistical methods ofdetermining whether it falls within or outside of the typical range.

For example, a waking time may be compared with thirty previous wakingtimes by determining whether it deviates by more than two standarddeviations from the arithmetic mean of the previous thirty waking times.This is one type of comparison of an individual data point with abaseline computed as a moving average of past events.

Controller 110 can be programmed to make decisions based uponcomparisons of new event data with past event data such as this. Forexample, machine initiated interventions and special data transfers orreports can be generated if a user appears to sleep more than twostandard deviations past the average waking time. In this case thetrigger event is the lack of a signal from the sensor configuration usedto establish that the user got out of bed. Thus, controller 110 need notremain programmed to expect the user to be awake at a predeterminedtime. Rather it can adjust and readjust the expected wake up time basedupon the past sleep and waking patterns of the user.

In a similar fashion, system controller 110 can be programmed to permitthe computing of average or typical expected values for any sensor baseddata or data derived from sensor based information. Programmingcontroller 110 in this manner requires programming it to permit storingand updating of moving averages and sigma values for time, duration, andfrequency of the activity and comparing the stored updated values toincoming data points.

System controller 110 can be enabled to change parameter settings inwhich variables are specified. For example, the number of medicationswithin a medication regime can be increased from two to three on a dailybasis. Using an additional position/compartment/switch provided on themedication monitor, the present invention can determine information forinitializing a new variable associated with the new medication and beginrecording time and date stamped information on its usage.

After several days, while the user takes the new medication, the averagetime and frequency baselines associated with the new medication becomestable.

Simultaneously, the sigma level (per. eg. two standard deviations) tendsto become smaller in terms of the number of measured units as the numberof observations increases. This permits system controller 110 to detecterrors such as taking too few or two many of the third medication in agiven day.

Other changes in parameters that can be learned by system controller 110are those associated with changes in meal preparation by the user. Anindividual user may have a pattern of preparing meals twice daily. Forexample, the user may normally prepare meals only in the morning and inthe evening. The user may only rarely prepare lunch. The timing,frequency and duration of the sensor correlates of meal preparationchange.

In principal, it is possible for the system controller to learn anypattern of repeated behaviors conveyed to it by a sensor capable ofsignaling the occurrence, non occurrence, time and duration of anyactivity event.

Activities of Daily Living: “ADL's”

ADL's (Activities of Daily Living/instrumental Activities of DailyLiving) comprise those goal oriented activities which must be performedby or for a person in order to live independently in their dwelling.These include bathing, transferring, dressing, eating, grooming, mealpreparation, light housekeeping, laundry, medication management, andother necessary tasks relating to personal care and householdmaintenance. We turn now to additional means for sensing and monitoringvarious activities germane to the current invention.

Toilet use can be monitored various sensor configurations. In thepreferred embodiment, a motion detector and a flush switch detector areused in concert with a pressure sensor/position sensor combination onthe toilet seat. The motion detector is placed in the bathroom andindicates the presence of individual(s) without regard to specificactivity.

Bed-wetting can provide a problem requiring monitoring in a variety ofsituations. Bed-wetting can be monitored by means of moisture sensorsplaced under the on the surface of an under sheet pad on which themonitored individual lies.

Meal preparation may be monitored by means of a combination of sensorsindicating the opening and closing of drawers, cabinets and appliancestypically used by the client to prepare meals. In one embodiment, therefrigerator door, the silverware drawer and the microwave weremonitored with reed switches to determine the presence, timing andduration of use corresponding to meal preparation. In an alternativeembodiment, electric current flow detectors could be used to record theuse of various appliances (e.g., coffee maker, toaster oven, etc.) usedin meal preparation. Additional heat sensor configurations could be usedto scan the stove. Pressure sensors, with or without weightdifferentiating means, could be used in the chairs at the eating table,etc.

For the current invention, variety of means have been developed toemploy a small radio frequency transmitter and movement sensing triggerwhich can be attached directly to household objects thereby conveying tothe system controller when these objects are manipulated. The preferredembodiment uses such an object movement detector (OMD) consisting of aninertia-momentum sensitive switch (mercury bulb or vibration detector)coupled to a transmitter with a timer/bounceless switch and timer resetwhich is small, low in current draw and which can be attached to theobject. When the object is moved/manipulated, a pulsed RF signal isemitted which identifies the object and is received by the localcontroller and time and date stamped. Such a jiggle detector can beattached to brooms and hairbrushes, electric razors and assisted deviceslike walkers and reachers.

Eating can be monitored through the use of pressure pad sensors ontables and chairs and if need be the use of OMD's on silverware.Housekeeping can be monitored by placing OMD's on broom, dustpan, vacuumcleaner to react to manipulation. In principal, any ADL/IADL can bemonitored by means of a configuration of sensors and this informationtransmitted to the local controller and integrated into the dailyactivity log for use by care providers or for machine initiatedinterventions such as reminders. Laundry activities can be detectedusing a current draw detector on a washer or dryer. The appliances'electric lines can be passively coupled to a current draw detectorconfigured to transmit a signal to the local controller when they are inuse resulting in time date stamp and duration data to be logged.

Grooming consists of a variety of behaviors, commonly inclusive of hairbrushing (for women), shaving (for men). This affords the possibility toattach an object movement detector (OMD) onto the hairbrush, razor, andother grooming implements to signal the local controller when thegrooming behavior is taking place.

Bathing can be monitored by several means. A variety of devices can becoupled to the plumbing to determine if water is flowing into thetub/shower. A water/moister detector can be placed in the tub or at theopening of the faucet/shower head to react to the presence of water flowwithout direct physical connection to the plumbing. A pressure sensitiveswitch in an insulated no slip mat at the bottom of the tub/shower couldbe fitted with an RF unit so when the individual steps or sits on thesurface the information is conveyed to the local controller. Each or acombination of these methods could be used to determine bath/shower useand transmit sensor data to the local controller.

Dressing consists of a complex ensemble of tasks requiring bothcognitive and manipulative functions. For this reason specialists ingeriatric functional assessment regard dressing as a benchmark ofoverall functional health and the length of time it takes to get dressedas an indicator of level of functioning sensitive to changes in ability.Dressing can be monitored by placing reed switches on the dresserdrawers and placing sensors in the closets can indicate the presence,time and duration of dressing activity.

Non-ADL Activity Monitoring

In addition to task oriented activities, there are repeatedly occurringbehaviors which are both important to the individual's lifestyle andindicative of their normal behavioral routine. This behavior includes arange of sedentary recreational activities such as television watching,radio or audio entertainment usage, computer usage, book reading,needlepoint, etc.

Such activities can be monitored in various ways. Those involving theuse of electronic or electrical appliances can be monitored by a varietyof means capable of determining when the appliance is on or off. Forexample, a television can trigger a current draw detector or a photodiode mounted on the corner of the CRT display. The detector should beconfigured to send data whenever the television is turned on or turnedoff so that it would be possible to log the time on time off on a dailybasis. Given the popularity of television and the relative regularitywith which it is viewed by many people, it may be useful to use thisdata in various ways. For example, behaviors whose change can bemonitored could include early and late television watching. Similartechniques could be employed in relation to CD, radio, VCR's, computers,etc. which could produce information indicative of normal dailyactivity.

For example, an individual may typically watch favorite programs in theafternoon between 2 and 5 pm Mondays through Fridays. This activity,while not directed toward achieving functional performance goals maybenevertheless an important part of the typical or normal daily routine ofthe individual. Changes in television viewing routine patterns, forexample not watching the afternoon shows or watching 14 hours oftelevision continuously may indicate a change of activity rooted in ahealth, cognitive or other problems and therefore may provide veryuseful information for reporting purposes or interventions. Thepreferred embodiment of the monitoring system television use ismonitored by means of a current draw detector. However, it is to beunderstood by those skilled in the art that many commonly used means ofdetermining whether the unit is on or off can be used to send a signalto the monitoring system. Furthermore, similar techniques could beemployed in relation to CD, radio, VCR's, computers, etc. which couldproduce information indicative of normal daily activity.

Distinguishing Among Several Individuals in Dwelling Unit

The present invention also includes means for distinguishing theactivities of individuals in multi individual dwelling units. It maysometimes be useful to separately log the activities of two or moreindividuals living in the same household. In the case of medicationadherence, this simply entails using separate medication monitoringcaddies for each individual, each caddy signaling the local controllerunit codes unique to the individual person being monitored. In the caseof other activities, such as transference, toilet use, bathing, mealpreparation, laundry and housekeeping it is necessary to introduce avariety of methods for distinguishing among multiple individuals andcreating a separate activity log for each individual. Described beloware a variety of methods that do not require the user to carry a specialdevice on their person and rely entirely upon the individualsinteraction with objects in their environment. Also described below is aspecial device, for example any type of transponder worn by theindividual, which emits a very short range signal detectable used todetect the proximity of specific individuals to objects in theirenvironment used in carrying out the monitored activities of dailyliving. In the preferred embodiment of the invention, the transponder ora similar device is not required for the system to work, but addsadditional information to increase the validity of the determination ofwhich individual is performing which task and when.

For transferring in and out of bed, it is possible to configure pressuresensitive switch pads on either side of the bed, on the floor, on themattress, or both. With knowledge of who routinely sleeps on the rightand who sleeps on the left, it is possible to configure these pressuresensors to indicate whether individual a or individual b is out of thebed.

For transferring onto chairs, it is possible to use a pressure sensitivesensor that responds to relative weight with sufficient precision as todistinguish between two individuals, such as a husband or wife. It maybe possible to know which chair is customarily occupied by whichindividual, especially in relation to a married couple.

For toilet use, the above described differential weight sensor could beinstalled in the toilet seat along with a tilt switch sensor to indicatewhen the seat is in the upright position (customary for male urination)or in the downward position. Additionally weight sensor pads could beembedded in a ‘bath mat’ in front of the toilet to assess weightdifferential. A variety of techniques could be used to signal toiletflushing, such as a flotation switch connected to an signaling unit suchthat when the water level in the tank drops below a threshold level, athe normally open float switch closes.

For bathing, a waterproof version of the weight sensitive bath mat couldbe placed in the bathtub to determine the differential weight of theperson.

With respect to differential weight, in most case it is useful in a twoindividual household and the weight threshold should be adjusted toapproximately the mean of the weight of the two individuals. Given thepossibility that either individual may loose weight over time (or gainwhich is rarer) and the two weights become close to equal, it may benecessary to repeatedly weigh the individuals. This can be doneunobtrusively using any known methods or just by wiring the scale andreminding the individuals to weigh in using his/her scales ortransponders or some other means for differentiating the weights.

Physiological Measuring of Health Conditions

The monitoring of health conditions among individuals in their dwellingunits consists of monitoring both their activities and theirphysiological functioning. A wide variety of physiological functioningmeasuring and monitoring devices are available for home use asvariables, including, but not limited to, body temperature, pulse rate,weight, blood sugar, blood pressure, and oxygenation. All of thesedevices, such as infrared temperature, blood sugar and pulse readers,are currently available with digital readouts and could be easilymodified to transmit the information to the local controller so thatthese physiological data could be recorded along with the activity dataand integrated into a single report combining both kinds of informationfor family and professional care givers as well as for triggeringmachine initiated interventions. Many devices for taking measurementsusable in accordance with the present invention are taught in Alyfuko,U.S. Pat. No. 5,410,471, which is incorporated by reference herein.

Furthermore, the system of the present invention can assist users in themeasurements. For example, in order to determine blood pressure a usercan be instructed by the system to be seated, put on the cuff andperform other required steps. If the readings obtained are not withinpredetermined ranges, the user can be instructed to repeat to themeasurement. This can be done by interactive software on the user's PCor by way of the internet.

An example of readings indicating intervention could be if a person isshowing an trend toward decreased activity during the day and is notsleeping in bed at night. This can reflect symptoms of congestive heartfailure (CHF). In this case decreased activity may be measured as fewertotal movements around the house, fewer total movements going in and outof the dwelling unit, less frequent or slower (longer average duration)stair climbing (where applicable), and/or longer sleeping hours. Thelocal controller could be programmed to trigger an intervention in viewof decreased activity and/or not sleeping in bed at night, which wouldentail a request/reminder for taking a blood pressure reading during thenext day. It could also plot the blood pressure against a continuousbaseline of previously taken blood pressures, and, if either diastolicor systolic pressures fall outside of upper and lower critical values(sigma levels), action could be taken informing the monitoredindividual, their physician and/or other appropriate persons of apossible change in health status. Instructions to seek checkups orcontact care providers can be the interventions indicated by the reportsof the present invention.

When the physician compares the blood pressure data, activity log dataand medication compliance data within an integrated health andfunctioning report, they are provided information invaluable for makingadjustments to therapy. For another example, frequent over nightbathroom use may indicate the presence of an infection. By combininginformation about toileting and body temperature readings in a singlereport, the physician or other care giver could be informed of evidenceof an infection and make sure that the monitored individual is quicklyseen by the appropriate providers. Again, it is possible to program thelocal controller to take action based on behavioral changes,physiological changes or a combination of the two. For example, thelocal controller may be programmed to request that the monitoredindividual take temperature and blood pressure or other measurementsafter night of unusual bathroom or other activity. In principal, anycombination of physiological measuring devices can be integrated intothe system by equipping them with a compatible RF transmitter andenabling these devices in the software.

In the various embodiments, the monitored individual is asked toparticipate in periodic automated check ups during which time they arereminded and prompted by the local controller to sit down at a table,take their temperature, take their blood pressure, etc. The controllerprompts them using a synthesized or recorded voice that can be heardthrough speakers connected to a personal computer wherein themicroprocessor of the local controller resides or a speaker phoneconnected to the local controller in the form of a stand alone unit. Theindividual is thereby instructed on what to do during the check up. Thedata captured by the controller is analyzed against the continuousbaseline average and the results reported to the remote monitoring site.Thus the present invention permits the integration of information withrespect to physiological and behavioral measures into a single reportfor human end users and/or machine initiated interventions.

Portability

While the current invention consists of various means for monitoringindividual user or users in a dwelling unit, there is no reason whyportable appliances could not be incorporated into the system. Forexample, a portable medication monitoring device could be carried by theuser out of the home. This device could be enabled to record and/orremind the individual to take their medications. Upon returning to thedwelling unit the medication unit is able to communicate by RF signalingto the local controller and information about medication taken outsideof the dwelling unit is integrated with the information about medicationtaken that was collected in the dwelling unit. Thus it would be possibleto integrate information about medication taking behaviors of the useroutside the dwelling unit with the information obtained within thedwelling unit to develop a more complete picture of the individualsdaily behavior.

In addition to portable medication monitoring, it is possible to haveportable physiological monitoring (e.g., heart, respiration, bloodoxygenation, blood pressure, etc.) and/or activity movement monitoring(e.g. odometer, walking odometer-like device, etc.) Likewise, similarlyto the above described portable medication monitoring, it is technicallyeasy to create data transfer channels and links integrate the signaldata gathered from the portable units within the home-based localcontroller and use this as the basis for the production of daily livingreports for human and machine use. Such reports and information productsmight prove very useful to maintaining the health and functionality ofusers.

Security and Environmental Monitoring

In addition to goal oriented functional activities and other behaviorswhich make up the routine everyday activity of individuals, themonitoring system of the present invention is capable of collecting andanalyzing information relating to security, safety and environmentalconcerns within the dwelling unit. As described above, variousembodiments of the monitoring and report generating system maybe used tolog activities relating to dangerous appliances, such as the stove, and,necessary, to take automatically initiated action in the event of aproblem, such as shutting off the stove if it is determined that it hasbeen left on too long or in the event that smoke or heat detector hasbeen triggered.

Also described above are means and procedures for monitoring bathtuboverflow, and in a similar manner, overflow of sinks in a dwelling unitBoth of these functions focus on detecting events that, if unchecked,may have serious negative consequences to the safety of the monitoredindividuals and/or the condition of the dwelling unit. In addition tothese functions, there is a wide range of additional events impactingthe security and safety of individuals and their dwelling units, whichmay prove very useful. For example, monitoring the closing and lockingof the door leading outside of the house or apartment, along withreports and reminders, would reduce the risk of security problems formany individuals. Forgetful or disoriented individuals may beparticularly helped by such a function. The monitoring of door closingand locking could be accomplished by a standard magnetic reed switchwhich opens and closes a circuit causing signals to be sent to the localcontroller in conjunction with a switch configuration fitted to thelocking mechanism in such a manner as to enable the detection of thestate of the locking mechanism as being either locked or unlocked. Thisswitch would then be connected to the appropriate signaling device toconvey information to the local controller so that the monitoring systemcould integrate this information into various reports and interventiondecisions.

Ambient temperature above and below healthful levels is a real threat tothe health and well being of frail elderly populations in particular.Each year heat waves and cold snaps kill scores, if not hundreds, ofolder people in part because of their physiological inability toadequately judge extreme and dangerous variation in ambient temperature.Many temperature detecting units, with either electronic or mechanicalthermostatic components, are familiar to those skilled in the art ofenvironmental control. Such units are commercially available androutinely used in the monitoring and control of heating and cooling ofbuildings. By connecting temperature sensors to the appropriatesignaling system, room temperature data can be transferred to the localcontroller, logged, analyzed and serve as the basis of machine generatedreports as well as interventions. In the preferred embodiment ofmonitoring system, temperature sensors are used to trigger alerts and,if need be, automatically initiated communication with care givers ifthe temperature rises above a high threshold or falls below a lowthreshold. This functionality can save lives.

In principle, the information from security and environmental detectorscan be integrated with the behavioral data within the local controllerand be used, in conjunction with the behavioral information, to enable avariety of interventions. For example, the system could be configuredand programmed to sense that the front door is unlocked, to note thatthere has been no movement in the dwelling unit since the door was shut,and take action by automatically locking the door. A variety ofalgorithms are possible for making interventions based on a combinationof security and behavioral data.

Similarly, temperature data could be used in combination with behavioralinformation to inform analysis and interventions. For example, anincrease in the amount of time an individual stays in bed along with theinformation that the room temperature has fallen below 50 degrees may beuseful information to family or professional care givers who need totake quick action to help the individual. As with door locking andphysiological measurements, there is no reason why environmentalvariables such as temperature could not be integrated into the reportsand interventions of the monitoring system. Other environmentalvariables may include, smoke and particulate dust detectors (such as anoptical smoke detector would measure) noise and vibration, carbonmonoxide, humidity, etc. Any environmental condition that can beautomatically detected using sensors could be used in connection to themonitoring system here described.

Internet

The use of the internet as a means of communication between the localcontroller and the remote monitoring site not only makes use of anefficient and cost effective means of exchanging information but alsoaffords the possibility of multiple users and various types ofindividual and institutional users to access report information postedby local controllers to a website. In one embodiment, a number of localcontrollers use a modem and automated dial up software to post activitylogs onto a website using email as the means of data transfer. Theposted email is then subject to interpretive post processing, convertedto a variety of summary reports for different users. For example,relatives of the monitored individual may access the website, type in apin number or password, and for access a report about basic day to dayactivities. Or a physician group at a hospital could access the websiteusing and institutional portal and be able to get a report on medicationadherence in greater detail than that available to the monitoredindividual family members. The remote monitoring station with itswebsite could also be programmed to store and process financial andbilling information relating to the access fees and report requesttransactions for the various individual and institutional clients. Forexample, family members might pay a relatively low monthly fee formonitoring and a small transaction fee for each report accessed while ahealth provider system right pay a substantially higher per month feeand report fee. Billing can be done by the remote monitoring sitecomputer along with the above discussed processing and transfer ofactivity information on the monitored clients.

Whereas the internet provides excellent means of exchange of informationin non emergency situations, it may be useful to couple the system to apager to call helpers and family in case of an alarm code. For example,if a monitored individual does not get out of bed before a critical timelapse, paging can be done in conjunction with or in place of phonecalls. Using alphanumeric display technology common in pager systems,the nature of the possible emergency can be designated using ASCII codesin place of the synthesized voice used on a voice telephone.

The internet can be used as a means of information transfer betweenlocal and remote controllers for any purpose. For example, the localcontroller can dial up an internet service provider (ISP), log on, andsend or receive packets of data for purposes of analysis, intervention,report writing, reprogramming, etc. The remote monitoring site,structured as a web page, can store, analyze and disseminate a widevariety of user reports in various ways. In one embodiment, the localcontroller is programmed to access the internet periodically (e.g. every6, 12, 24 or other number of hours) and transfer data to a remote sitein the form of web server. The remote monitoring site receives theinformation and makes it available to the client, family, professionalcare givers, case managers, health care providers and others who canaccess this information by logging on and entering secure portals usingstandard identification and password protocols. This enables a widevariety of users to make queries of the reports, analysis and recordsbased on the monitored client(s).

Furthermore, the plurality of user portals by which clients: (i.e.,monitored individuals), family members (informal care givers), healthproviders, social support agencies (formal care givers), can each accessclient information at will could be used to automatically create atransaction record usable for information tracking and billing purposes.FIG. 12 below illustrates an embodiment of an internet web site withmultiple user portals. In this way, clients and other subscribers can betracked and billed for information accessed in a wide variety of ways.In one embodiment, clients, gain free access and registered familymembers can make a number of included queries per month with a per querycharge thereafter. Hospitals can also be charged a per query fee.

In addition to placing client information on a web server and allowingregistered users to access the information, it is also useful toperiodically transfer information and reports to subscribers via e-mail.Thus family members, physicians, case managers and others can receiveperiodic machine generated reports on the client (daily, weekly,monthly, etc) via email which may be received on one's computer or anyother device capable of receiving email messages. In addition, emergencyor quick response options for information transfer via the internet areafforded by linking the internet with a wide variety of wirelessdevices, including, but not limited to cell phones, pagers and personaldata assistants. For example, if a monitored individual does not get outof bed before a critical time lapse, paging can be done in conjunctionwith or instead of phone calls. Using alpha numeric display technologycommon in pager systems, it would be possible to designate the nature ofthe possible emergency using displayed printed words in place of thesynthesized voice used on a voice telephone. The lining of localcontroller 100 and the remote monitoring site via internet as acommunication channel need not alter the essential features of the localcontroller and remote monitoring site. The local controller can be usedfor obtaining, storing, organizing and analyzing sensor based data inthe dwelling units of the monitored individuals. As mentioned above, itis possible to configure/program the local controller to carry out manyof the functions of the remote monitoring site. Thus a wide variety ofembodiments with differing amounts of functionality distributed amonglocal controllers and remote monitoring systems are possible. Inprincipal all functions of report generation, automated behavioral andphysiological profiling, machine initiated reminders and interventionscan be carried out for individuals within a single dwelling units by thelocal controller. It is therefore possible to greatly reduce the numberand complexity of functions of the remote monitoring site as long as anend user receives information about the client from this site.

In one embodiment the remote site is reduced to a pager, phone or radioreceiver, which signals care givers and others when the client is inneed or reports information via synthesized voice or displayed text. Inthis case the functionality of the local controller is maximized and theremote monitoring site minimized. On the other hand it is possible tohave a monitoring system configured whereby sensors are placed in adwelling unit and the local controller consists of no more than a systemfor gathering their outputs into a usable communication channel whichthen is processed by the remote monitoring site. This would be aminimalized local controller dependent for data analysis functionalityalmost entirely by the remote monitoring system. In the preferredembodiment, higher level functions of case management pertaining to thecollection and analysis of data on single or many individuals in singleor many dwelling units are carried out by a remote monitoring systemwhereas local controllers function primarily to log, analyze, report andmake automated inventions based on sensor data within a single dwellingunit and the local controller is in the dwelling unit and that theremote is not.

The ubiquity of the internet makes it a preferred means of communicationlink between the local controllers and the remote monitoring site. Thereare various means of transferring data to, through and from the internetknown to those skilled in the art. In a preferred embodiment thecommunications link between local and remote monitoring sites can beestablished and maintained by email. The activity log is simply uploadedas a text file and mailed to the remote site, which receives it, placesit in the correct mailbox, processes it and then may automatically sendout reports via email to end users (e.g., family, physicians, socialworkers, etc.), or posts reports on a secure website accessible bypassword to family and professionals.

Referring now to FIG. 12, the preferred embodiment of the internet basedremote monitoring site is organized in the form of a web page 1001.Webpage 1001 allows clients to access information about the monitoredindividuals by means of client portals. Two portals are shown. Theindividual portal 1007, allows the monitored individual and designatedindividuals (such as family members) to access the behavioral and otherinformation which is accumulated and integrated by the local controllerand transferred to the internet by any variety of commonly used means.The institutional portal 1008, allows for institutions (e.g., healthcare providers, case management service units, insurers, etc.) to accessinformation about monitored client). In the preferred embodiment theseportals make use of commonly employed means for assuring security of theinformation about individual clients such as the use of PIN numbers,encryption, firewalls, etc. to assure that only authorized parties areable to access secured information. In principal, any number of portalscould be used to accommodate different groups of clients with differingaccess to information.

A report generator 1002, a data base of monitored information 1003, andan incoming data portal 1004 form the means for generating a widevariety of reports from data accumulated by the local controller. Theincoming data portal 1004 receives packets of information from anynumber of local controllers. In this embodiment, e-mail serves as themeans for data transfer wherein the incoming data portal is configuredto receive from the monitored individuals. The data base of monitoredinformation 1003 contains a client background record of each monitoredindividual which includes demographics, medical and functional needs,plus billing information (e.g. postal address, phone number, etc.).

With respect to the data coming in from the incoming data portal 1004,the data base of monitored information 1003 also sorts and stores datafiles for each individual local controller, automatically updates thedata base with newly received, information and maintains an a record ofinstructions which determine the form, content and receiver of reportsto be generated by the information. These instructions include, but arenot limited to, the type and number of monitored events to be includedin a given report, the particular type of summary used within the report(counts, sums, averages, critical levels, verbal descriptions of events,graphical descriptions of events, etc.), the frequency of the reportingperiod (hourly, daily, weekly monthly, etc.) as well as informationpertinent to the receiver of said reports (name, relationship, e-mailaddress, phone/pager numbers, postal address, etc.).

In this way the data base of monitored information 1003 includes thelocal controller accumulated data plus additional information about themonitored individual, the reports to be generated, and the parties toreceive these reports. At time intervals determined in individual recordinstructions contained in the data base of monitored information 1003,the data is processed through the report generator 1002 wherein avariety of reports are produced reducing the data collected by the localcontroller to numerical, graphical and written reports. These reportsare then saved transferred to the report sender 1006 which can sort,store and transfer the reports to a variety of end users by meansincluding e-mail, automated or live human telephone calls, voice/alphanumeric paging and postal mail by means of printing the report on paperand physically sending it to the appropriate customer. Any single orcombination of commonly used means for conveying numerical, graphicaland written information can be used.

The preferred embodiment uses e-mail for non-priority reports and pagingand telephone messaging for priority reports/alarms. Billing reportgenerator 1010, billing data base 1005 together provide a means fortracking customer billable usage of reports and queries. For example,each query from a family member may be tracked, a per query cost totaltallied, and an end of the month usage statement produced which canserve as the basis of a bill. Similar procedures could be in place forinstitutional customers: a hospital may contract for 1,000 queries amonth, pay a set amount, and then pay an additional amount per querywhen the contracted number is exceeded. The operation of billing reportgenerator 1010 and billing data base 1005 require linkage to themonitored client data base 1003 so that information about the form andcontent of the reports, as well as customer and client information couldbe used to develop the billing reports. In addition, linkage with thereport sender 1006, especially in so far as it sends reports by postmail, would be useful as a necessary means for printing and distributingthe bill at the end of the billing cycle. Using means commonly employedin automated and semi automated billing systems, it is possible toconfigure the data bases in a number of ways with billing reportgenerators to accurately and efficiently generate bills for servicesprovided.

The above description of the internet based remote monitoring site alsoincludes functions for reprogramming and maintenance of the localcontrollers 110. The previously described reprogramming function iscapable of resetting parameters controlling data collections andinterventions, as well as testing and status checking of localcontroller and its network of sensors. Such functions may prove usefulif not essential in the development of various installations of themonitoring system.

It should be pointed out that any functionality described above asembodied in the monitored client data base 1003 could in a givenembodiment be located in the report generator 1010 and that anyfunctionality described as part of the report sender 1006 could inactuality be located in the report generator 1002 or monitored data base1003. In principal, it makes no difference where the functionality isembodied relative to the conceptual block diagram, as long as thefunctionality exists.

Monitoring Caregiver Performance

Various health and wellness monitoring systems have been devised tocollect information regarding the physiological, environmental andbehavioral status of individuals for use by caregivers. Telecare,telehealth and social alarm systems are known in the art and have beenimplemented around the world with the intent of efficiently providingthe right care by the right person at the right time. Telehealth systemsusing video/audio conferencing technologies along with standard clinicaltools such as blood pressure cuffs and thermometers have allowed healthprofessionals to carry out “remote” visits to their patients. Socialalarm systems have been deployed to establish urgent communicationbetween a monitored individual and a remote care center enabling quickresponse in emergency situations. Passive actuation of such alarms (notrequiring the monitored individual to physically send the alarm) istaught in various references and is implemented in numerous workingsystems (e.g., Tunstall fall and smoke detection). Monitoring of aperson's behavior, including goal-directed functional activities ofdaily living, has been taught and tested and in some casescommercialized, as in the case of U.S. Pat. Nos. 5,692,215 and 6,108,685issued to the inventors of the instant application.

All of these systems provide actionable information for careprofessionals and family caregivers about the status of the monitoredindividual. Actionable information, whether in the form of telephonecalls, call center alarms or web-based reports, can only be useful tocaregivers if it is in fact used by caregivers. Furthermore, saidinformation on the status of the monitored individual can only bereliable and valid information within the caregiving process if it isproperly and adequately received interpreted and acted upon by thepersons and organizations providing care. Put otherwise, even perfectlyaccurate information about the status of the monitored individual canhave no positive impact on the delivery of care if the caregiver neverreceives it, interprets it, and does not take appropriate action inresponse to it. For this reason the actions of the caregiver(s)determine the effectiveness of behavioral, vital signs and environmentalextreme monitoring as much if not more than the design andimplementation of the hardware and software of the monitoring devicesand systems.

With reference to FIGS. 13-19B, given the centrality of caregiveractions in determining the effectiveness of monitoring systems as toolsfor better care provision, it would be very useful to monitor theactions of the caregivers to assure the quality of these actions. In themost rudimentary sense, the monitoring could include the recording ofcaregivers receiving the information from the monitoring system(s), thelogging of their interpretative actions as they determine the presentstatus of the monitored care recipient, the tracking of actions taken bythe caregiver(s) in response to their client's status, and finally, theability to register the impact of these actions on the client's care interms of alteration of a care plan or other interventions in a data basefor the purpose of producing a variety of reports and analyses relatingquality and quantity of care delivered and received in the caregivingprocess.

The preferred embodiment of the present invention combines informationsuch sensor-based, objectively derived information with informationentered into a care tracking data base by persons using keyboards,computers, PDAs, etc. in order to produce an integrated electronicWellbeing Record. Such a record can track care delivery and provide thedata for generating a variety of analytical reports as well asinitiating a variety of machine initiated and human initiatedinterventions. In particular, the Wellbeing Record can be used toprovide information such as continuous baseline assessment informationand evaluation of the changing status of the care recipient in relationto specific care actions provided by professional and family caregiverswithin, but not limited to, the following seven domains: (1) trackingchanges in care recipient outcomes; (2) tracking changes in caredelivery practice; (3) analyzing individual outcomes for clientwellness; (4) analyzing systemic/organizational outcomes for caregivingeffectiveness; (5) assessing cost and cost benefits of caregivingactions for paid services; (6) assessing the effectiveness of specificcare actions and interventions for individual care recipients in termsof client wellness outcomes; and, (7) assessing the effectiveness ofspecific care actions and interventions in terms of determining the mosteffective caregiving actions.

Taken together these domain related functionalities can provideinformatics templates to enable the effective use of various telecareand telemonitoring tools within a care delivery system by continuouslyproviding feedback about the effectiveness of ongoing care provisionboth on the individual and organizational level.

Core Functionality

The Core Functionality of this invention resides in recording andanalyzing the actions of caregivers in response to alerts generated by avariety of telecare systems and/or information about the status of oneor more care recipients gathered by traditional non-telecare means.

With respect to telecare applications, the preferred embodiment of thisinvention makes the following ten determinations are made in connectionwith the actions of the caregiver; 1) Has the caregiver received thealert?; 2) Has the caregiver recorded receiving the alert?; 3) Has thecaregiver taken an action or actions?; 4) What actions have been takenby the caregiver and in what sequence?; 5) Does this sequence of actionsfollow the caregiving protocol?; 6) What is the decision tree map of theactions taken?; 7) How do the actions deviate from the specified (i.e.,etic) caregiving protocol?; 8) Do the actions conform to the pastactions taken by the caregiver?; 9) Do the actions conform the pastactions taken for the client by their caregiver(s)?; and, 10) Do thecurrent actions conform to the actions taken by the specific caregiverfor the specific client?

The determination as to whether the caregiver has received the alert isaccomplished by recording the opening and reading of the alert by thecaregiver. This may be done by automatically logging the opening of awebpage on the caregivers pin secured portal corresponding to a specificalert, for example, an alert that a user may have not arisen out of bedafter a threshold time of day. In addition, the caregiver is prompted torecord an acknowledgment that they have received the alert. In thepreferred embodiment, the caregiver may simply check a checkbox toindicate any and all alerts they are responding to at the time ofintervention. This information is recorded into the Wellbeing databasefor further analysis, including, but not limited to a counting andstatistical analysis of the number, types and contexts of alerts thatare responded to and alerts that go unheeded.

The determination as to whether the caregiver has taken action(s) inresponse to the alert is accomplished by having the caregiver recordeach action taken as the response(s) is/are carried out. In thepreferred embodiment the caregiver interacts with graphic interfacewhich presents a combination of “radio buttons” and checkboxes to recordthe actions taken. For example, if the alert indicates that a carerecipient did not get out of bed, a highlighted icon is presented to thecaregiver with the image of a telephone and clicking on this iconinitiates the dialing and/or records the fact of calling the carerecipient to determine if they are in need of assistance.

A second means or recording whether a caregiver has taken action is togather information from a variety of sensors at the dwelling unit of theuser, including a sensor based means for determining if the caregiver ispresent in the dwelling unit at the time of the caregiving actions. Inthe preferred embodiment, the caregiver might wear radio frequencyidentification (RFID) device configured to trigger the local controllerand record the start and ending times of the presence of the caregiver.In this way it is possible for the system to passively obtaininformation on the caregiving action. Depending on the nature of thecaregiving process and the sophistication of the sensor arrays andcontext aware computing, embodiments of this invention my employ avariety of accelerometers, video image processing, vibration analysistechniques to further determine the specifics of the actions of thecaregiver in addition to whether or not they were present at the carerecipient's dwelling unit and for how long.

The determination of specific types of caregiving actions and theirtemporal sequence is accomplished as well by a combination of activedata entry on the part of the caregiver and passive, sensor-based datacollection. On the one hand the caregiver may enter via keyboard, mouseclicks and/or PDA screen what actions they are taking in the order inwhich they are occurring. On the other hand, sensors in the dwellingunit of the user give additional information about the sequence ofevents taken. For example, in determining the occurrence of a homehealth aide showing up at a particular time in the morning to help theuser out of bed and into the bathroom, it is clear that the behavioralmonitoring system described in Kutzik et. al. (U.S. Pat. No. ______) canbe used to determine whether or not the home health aide carried outtheir assigned tasks and even be programmed with rule-based algorithmsto send out alerts in the event that the particular timing and sequenceassociated with actions of a home health aide does not occur (per e.g.,the sensor-based “footprint” of entry at front door, proceeding throughthe hallway to the user's bedroom followed by a minimum number ofminutes of activity in the user's bedroom as specified by a movinghistorical average of the number of minutes so spent over a selectednumber of previous days, etc.).

In principal, footprints of complex caregiving actions can also beconstructed and detected using sophisticated arrays of sensors. Forexample, a nurse may enter a patient's room, her presence indicated byrfid. She then takes the blood pressure, temperature and proceeds tocarry out the sequence of steps necessary to change a bandage on awound. Using wrist worn accelerometer units and video cameras with avariety of automated image processing techniques, it is possible toestablish the timing, sequence and duration of the skilled medical caredelivered. Furthermore, in so far as the nurse records her actions andthe patient outcomes on her PDA, the information from the objectivelyderived sensor data can be compared with the nurse's account of heractions.

It should be noted that, depending on the particular caregivingprotocol, i.e., the rules governing the actions of the caregiver inresponse to the needs of the care recipient, there may be considerablevariation in the proportion of objectively derived sensor-basedinformation versus information inputted by persons. In principal theprocedures here described should be able to operate in any configurationranging from all of the information coming from sensor-based remotemonitoring devices to all of the information resulting from human dataentry.

Caregiving Protocol: Etic and Emic

A caregiving protocol consists in the set of rules followed by familycaregivers and/or professional caregivers that govern the sequence ofactions taken in providing care to the care recipient. In the case offamily caregivers, this is typically an informal or “emic” protocol,neither written down nor officially sanctioned as the correct set ofprocedures. On the other hand, the caregiving protocols of providerorganizations employing professional and paraprofessional caregivers ofvarious types (e.g., visiting nurses, occupational therapists, socialworkers, home health aides, etc.) are typically codified, officiallysanctioned, and to some extent monitored as part of quality assuranceand supervisory functions of the organization.

In the preferred embodiment of the present invention, the caregiveralert-action-response tracking system protocol would require that thecaregiver respond to all alerts from behavioral and/or vital signsmonitoring system by following a predetermined care action-responsedecision tree. Such a decision tree spells out the sequence of actionsand contingencies of what a caregiver is supposed to do at each step ofthe caregiving protocol. Using a “wake up” alert as an example, thefollowing illustrates the operation of a caregiver protocol.

A caregiver is sent one or more email, text message or cell phone alertsindicating that the care recipient has apparently not gotten out ofbefore a time that triggers an alert condition. As soon as the alert isreceived, the caregiver is required to acknowledge receipt of the alert.Next the caregiver is required to call the care recipient. If this phonecall results in user answering the phone, a series of questions areasked to see if they are in need of help. If the questions are answeredin the appropriate manner, the sequence of caregiving actions may end.On the other hand, if this phone call to the care recipient goesunanswered, the caregiver is then required to call a designated personwho may directly check on the condition of the care recipient, perhaps aneighbor with a key. Failing this contact, the caregiver may be requiredto personally attempt direct entry into the user's dwelling to make surethey are alright. Depending on the specifics of the caregiving protocol,the caregiver may be required to call 9-1-1 to gain entry into the carerecipient's dwelling unit.

At each step of this protocol, the caregiver is presented with a set ofchoices. These choices may reflect relatively simple protocol responsesto alerts, as above, or may be much more detailed and complex, such asthose involving multi-stage skilled medical interventions. But in allcases the protocol can be represented as a decision tree “map” or flowchart like the one in Figure XX. In the preferred embodiment of thepresent invention, the caregiver may be presented with a list of choicesas “prompts” on a device interface in textual and graphical formenabling them to see which choices are available within the constraintsof the protocol at each step of the process.

In the preferred embodiment of the present invention, it is possible toautomatically make use of a decision tree map by entering the sequenceof protocol instructions into the database and analysis software suchthat any given sequence of actions taken by the caregiver can becompared with one or more caregiving protocol maps to determineconformity and deviation from the protocol. Two types of protocol mapsmay be employed, etic and emic. In an etic protocol map the sequence ofactions, contingencies and decisions are keyed into the database by ahuman being and represents the steps of the generalized etic protocol.Alternatively, the emic protocol map represents the sequences ofactions, contingencies and decisions are inferred from previouslycollected data on caregiving alerts and responses. Thus the emicprotocol map is derived from empirical historical data of actions takenbe caregiver(s) in relation to care recipient(s) and as such isrepresentative of the real, empirical caregiving alert, decision,response-action process whereas the etic protocol map is representativeof the ideal caregiving process. This derivation uses a variety ofpattern recognition and sticky function programming techniques wellknown to those skilled in the art. Again using the above example ofprotocol response to an alert indicating that a care recipient has notgotten out of bed, the etic protocol map may simply indicate that thecaregiver should immediately call the care recipient and then follow thedecision tree of contingencies and actions flowing from the set of‘if-then’ rules entered by a person. On the other hand the emic protocolmap would track each action taken by the caregiver and record itstiming, sequence and, if applicable, its duration. Each time thecaregiver clicks or checks an alert or action button, the system recordswhat is done and/or each time the caregiver or another designated personenters the dwelling unit of the user/care recipient to check on theirstatus, the system records the timing and duration of the visit using asensor array-based behavioral monitoring. These data are then translatedinto a sequence of steps taken from the receipt of the alert to the endof the caregiving intervention actions which are recorded in thedatabase for later analysis and the production of caregiving reports.

It is well known to those familiar with the practice of family andprofessional caregiving that it is extremely important to identify andtrack alerts that go unheeded and lead to no caregiving actions orinappropriate delays in response. These conditions can be routinelyflagged and analyzed. In addition the more subtle problems relating toactions that are simply not the best choices can also be identifiedthrough review of case records and these flagged as well.

In the preferred embodiment of the current invention, the emic protocolserves not only to provide information for the basis of the generatingcare provision reports that assess the quality, quantity and efficiencyof care actions for individual caregivers, individual care recipients aswell as aggregate level analyses and reports, but also as the basis forsticky reminder functions enabling prompts to the caregiver along thelines of “the last three times you responded to this type of alert youtook the following actions” or “the last time you called this client andthere was no answer, you called Mr. Smith the next door neighbor”. Inthis way the present decisions and course of caregiver action may beinformed by past decisions and actions using elements of the emicprotocol.

At the core of the inventive concept as it relates to etic and emicprotocols, is the ability to compare of each particular instance ofcaregiving action to both the etic and emic protocol map. In this way itis possible to examine the deviance or variation from the expected(i.e., etic) behavior of the caregiver with the real (i.e., emic)behavior of the caregiver. Such variance could be coded, given numericalexpression and subjected to a wide variety well known of quantitativeanalytical techniques. Assessment indexes could be constructed toexamine the efficiency of the caregiver and/or aggregate caregivingprocess, such as in the simple case of the above example, the averagenumber of minutes elapsed between an alert and the appropriate responseby the appropriate person. Rule-based categorical and/or classificationanalyses could be conducted to assess whether or not there has been theappropriate action(s) taken and to calculate the percentage and describethe type(s) of inappropriate actions. A simple example of a rule-basedcomparison between etic and emic maps would query the database as towhether each of the specified caregiving actions listed in the eticprotocol were empirically recorded in the course of giving care to thecare recipient whether these actions were carried out in the prescribedorder. A similar comparison can be executed comparing the caregivingactions to the emic protocol map to ascertain whether in what ways theseactions conform and/or deviate from these baselines. Such informationcould prove invaluable in quality assurance and best practice analysisfor caregiving in virtually all contexts.

Reporting Functionality

Since information about the caregiving process can only useful andactionable if it is received, interpreted and effectively integratedinto the care provision process, the Wellbeing Record of the currentinvention need be presented in useable reports corresponding to acaregiving informatics template.

A caregiving informatics template is a set of information productsneeded to provide the appropriate feedback about the caregiving processfor evaluation and quality assurance. In a general sense such a templateis similar for all users. But in each particular case the template iscustomizable to the specific information needs of the caregiver users.The template manipulates information and provides reports on alerts,actions, outcomes or any other event required. For example, a particulartemplate may collect and/or select information and provide reports aboutthe amount of time passing between the sending of the alert and theresponses(s) from the caregiver(s) whereas another version of thetemplate may provide detailed information on blood pressure and weight.Templates include the capability of enabling an integration of textualcare notes reporting on the changing status of the care recipient withother information sources. These care notes record the observations andassessments of caregivers and provide an additional layer ofinformation, especially as regards the impacts and outcomes of thecaregiving process on the care recipient. Since such impacts andoutcomes often difficult to measure in purely quantitative terms, thequalitative narrative-based care notes information allows for a richerunderstanding of the quantitative data collected by other means.

In the preferred embodiment of this invention, the caregivinginformatics template integrates information from behavioral, vital signsand environmental extremes monitoring to create two basic types ofreports and information products: a set of Individual Wellbeing Reportsfocusing on the individual care recipient(s) and a set of Care TrackingReports focusing on the performance of the caregiver(s).

The Individual Wellbeing report may contain information about remotemonitoring alerts, including but not limited to type, time, duration,past history of similar alert events. The individual Wellbeing Reportalso contains information entered by caregivers and other persons aboutthe status of the care recipient, including but not limited to, theobserved outcomes of the actions taken in the course of caregiving. Forexample, if an alert indicating that the client may have fallen in theirhome is received by the caregiver, the report integrates thisinformation with information gathered by the caregiver or designatedindividual who determines the actual status of the care recipientfollowing the alert. In the preferred embodiment, these individual carerecipient reports provide both graphical and text/narrative informationon the alerts, responses and outcomes. These include an a detail pagegiving information on each alert set, caregiving response and outcome, aseries of pages detailing the past history of alerts, responses andoutcomes, and trend analytical report pages which analyze changes incaregiving actions overtime using both rule-based and trend analyticalmethods. Thus the individual care recipient report may provide ananalysis of even subtle changes overtime with respect to alerts, nonalert conditions (small changes in, for example, blood pressure orweight), changes in response actions and timing of the caregiver(s),etc. While the specific form and content of said reports may differ fromone care delivery setting to another, the function of the report is topresent information from a continuously updated electronic record ofcare for the care recipient for use in the guiding the caregivingprocess. This also results in a clear record of care received by therecipient, with data that can be used for quality assurance and billingpurposes.

The Caregiver Tracking Report provides a series of pages presenting thenumber, timing and types of caregiver actions taken in relation to eachindividual care recipient for which the caregiver is responsible. Thisreport may present information on a single caregiver or any group ofcaregivers in aggregate. In one embodiment, an aggregate view of allcaregivers is presented as a “supervisory view” in which anadministrator of a care delivery organization may compare the variouscaregivers in terms of various measures of efficiency as well as theextent to which they follow the etic protocol map in their work. Suchinformation as non response to alerts as well as inappropriate actionscan be logged, analyzed and subjected to trend analysis. Incidents ofinappropriate action on the part of caregivers may be flagged and eventreated as alerts, and in turn, subjected to comparative and trendanalysis.

While the specifics of the form and content of the Individual WellbeingReport and the Care Tracking Report are intended to be customizable andtherefore vary from one caregiving setting to another, it is possible togive generalized examples of the preferred embodiment in terms of form,content and procedure of use.

The Individual Wellbeing Report has multiple configurations, eachtailored to the information needs of the user, so that there may be oneversion for formal caregivers, another version for family caregivers anda third for the care recipient themselves. Typically these reports arepresented graphic interface in which the first page is a “snapshot”representing the current status of monitored conditions and caregivingresponses. This page is periodically updated to provide real or nearreal time refreshing of the information. Using graphical and textualcontent, the current status is represented as either “all is well” or“pay attention to” which informs the reader as to whether any immediateaction may be required and also indicates the time of the informationwas last updated. If the “pay attention to” status is indicated, theuser then clicks on a radio button to open a second report page whichprovides alert information about the care recipient's condition and/orthe actions of caregivers. The care recipient status alerts may includebut not be limited to an alert that the care recipient did not get outof bed, was unusually active through the night, is having an unexpectedincrease in bathroom use, has not taken their blood pressure, has had asignificant weight gain, etc. The caregiver action alerts may includebut not be limited to such events as caregiver(s) not checking, readingor responding to the monitoring system web, caregiver(s) not showing upat a care recipient's home for a scheduled visit, caregivers deviatingfrom the etic or emic care protocol, etc. In addition to the alert page,several other pages of detail are available for “drill down” by the userto examine care and alert conditions history of the care recipient.These pages include textual summaries of alert activity and caredelivery reports as well as trend analysis reports graphicallypresenting an examination of relatively subtle changes in alerts,actions and outcomes over time.

The Care Tracking Reports are intended primarily for professional caredelivery organizations. They focus on the actions of specific caregiversand are intended primarily as administrative reports that serve avariety of quality assurance, accountability, supervisory and businessrelated reporting functions. A central feature of these reports isdocumentation of services delivered and the determination of the needfor additional services to be delivered. As such, the Care TrackingReports provide ongoing case management level assessment useful forrevising care plans, especially when this entails the provision ofhigher levels of support and services to the client base. While theform, content and procedure of use for this reporting system is expectedto vary among different care providers, the preferred embodimentincludes a first page detailing the past actions of a caregiver over thecourse of a reporting period (e.g., monthly, bimonthly). These actionsmay include but not be limited to phone calls to care recipient, homevisits, meetings with family members, conferences with health and careprofessionals, assessment or reassessment of the care recipients' needs,adjustments and changes in the quantity and type of care delivered, etc.Additional pages of the reporting system allow for analysis of the careof any particular care recipient provided by this care giver as well asan analysis of efficiencies and deficiencies in the care actionsdirected at the caregiver's entire case load. Furthermore, the inpreferred embodiment of the current invention, the Care Tracking Reportwould allow for aggregate analysis of the whole group of caregivers interms of their productivity. These analyses may include but not belimited to the number of alerts, number and types of responses, degreeof following versus deviating from the caregiving protocol(s), thenumber and type of changes in care plans of the caregivers' case load ofcare recipients, as well as the amount and type of billable servicesdelivered to each of the client care recipients of each of thecaregivers.

It will be appreciated by those skilled in the art that changes could bemade to the embodiment described above without departing from the broadinventive concept thereof. It is understood, therefore, that thisinvention is not limited to the particular embodiments disclosed, but itis intended to cover all modifications within the spirit and scope ofthe present invention as defined by the appended claims.

It will be appreciated by those skilled in the art that changes could bemade to the embodiment described above without departing from the broadinventive concept thereof. It is understood, therefore, that thisinvention is not limited to the particular embodiments disclosed, but itis intended to cover all modifications within the spirit and scope ofthe present invention as defined by the appended claims.

1. A method for determining the performance of a caregiver in amonitoring system for monitoring a user in a user living area themonitoring system including a remote monitoring site, comprising;monitoring said user living area to detect an occurrence of an event toprovide a detected event; providing event information representative ofsaid detected event; determining a response of said caregiver to saiddetected event to provide caregiver response information; andtransmitting said event information and said caregiver responseinformation to said remote monitoring site.
 2. The method fordetermining the performance of a caregiver of claim 1, furthercomprising detecting said detected event by a sensor.
 3. The method fordetermining the performance of a caregiver of claim 1, furthercomprising determining said response of said caregiver using anelectrical sensor.
 4. The method for determining the performance of acaregiver of claim 1, further comprising determining said response ofsaid caregiver in accordance with input from said caregiver.
 5. Themethod for determining the performance of a caregiver of claim 1,further comprising providing a history in accordance with said eventinformation and said caregiver response information.
 6. The method fordetermining the performance of a caregiver of claim 5, furthercomprising providing a user history in accordance with said eventinformation and said caregiver response information.
 7. The method fordetermining the performance of a caregiver of claim 5, furthercomprising providing a caregiver history in accordance with said eventinformation and said caregiver response information.
 8. The method fordetermining the performance of a caregiver of claim 7, furthercomprising comparing said history with said caregiver responseinformation to determine a difference between said history and acaregiver response.
 9. The method for determining the performance of acaregiver of claim 1, further comprising determining a outcome of acaregiver response.
 10. The method for determining the performance of acaregiver of claim 9, further comprising determining changes in saidoutcome of a caregiver response in accordance with said history.
 11. Themethod for determining the performance of a caregiver of claim 7,further comprising determining changes in said caregiver response inaccordance with said history.
 12. The method for determining theperformance of a caregiver of claim 5, further comprising generating areport in accordance with said history.
 13. The method for determiningthe performance of a caregiver of claim 12, further comprisinggenerating said report in accordance with a template.
 14. The method fordetermining the performance of a caregiver of claim 12, wherein saidcaregiver is provided with a response protocol further comprisingcomparing said caretaker response with said protocol.
 15. The method fordetermining the performance of a caregiver of claim 5, wherein saidmonitoring system includes control parameters at said user living areafurther comprising: performing a statistical operation upon said historyto provide a statistical determination; and adjusting at least one ofsaid control parameters in accordance with said statisticaldetermination.
 16. The method for determining the performance of acaregiver of claim 5, further comprising: performing a statisticaloperation upon said history to provide a statistical determination; anddetermining cognitive function information of said user in accordancewith said statistical determination.
 17. The method for determining theperformance of a caregiver of claim 1, further comprising: activating atleast one sensor in response to an occurrence of a first type ofbehavioral activity and an occurrence of a second type of behavioralactivity differing from said first type to provide respective first andsecond behavioral activity information representative of said first andsecond differing types of behavioral activities; using a furtherdetector device determining a value of a physiological parameter in saiduser living area to provide physiological parameter information; first,second and third control signals generated respectively in response tosaid first and second differing types of behavioral activity informationand to said physiological parameter information; a communication channelfor applying said first, second and third control signals to said remotemonitoring site; and a remote generator for; distinguishing said firstand second differing types of behavioral activity and aid physiologicalparameters in accordance with said first, second and third controlsignals; and generating an integrated report in accordance with saiddistinguishing.